Healthcare Provider Details

I. General information

NPI: 1639851405
Provider Name (Legal Business Name): MARIA IBARRA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S MAIN ST STE 3
KENNETT MO
63857-3039
US

IV. Provider business mailing address

103 S MAIN ST STE 3
KENNETT MO
63857-3039
US

V. Phone/Fax

Practice location:
  • Phone: 573-840-0440
  • Fax: 870-324-5121
Mailing address:
  • Phone: 573-840-0440
  • Fax: 870-324-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023030321
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: