Healthcare Provider Details

I. General information

NPI: 1871667568
Provider Name (Legal Business Name): JENNIFER S HIDROBO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N SAN ANTONIO RD
SANTA BARBARA CA
93110-1399
US

IV. Provider business mailing address

2400 HIGHWAY 154
SANTA BARBARA CA
93105-9797
US

V. Phone/Fax

Practice location:
  • Phone: 805-884-1681
  • Fax:
Mailing address:
  • Phone: 805-884-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number626
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number28042
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW64874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: