Healthcare Provider Details

I. General information

NPI: 1831023761
Provider Name (Legal Business Name): SANDRA RIBALTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5668 VILLAGE POND CIR
JACKSONVILLE FL
32222-1158
US

IV. Provider business mailing address

5668 VILLAGE POND CIR
JACKSONVILLE FL
32222-1158
US

V. Phone/Fax

Practice location:
  • Phone: 786-238-0737
  • Fax:
Mailing address:
  • Phone: 786-238-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: