Healthcare Provider Details

I. General information

NPI: 1730362500
Provider Name (Legal Business Name): ANGELA R. YBARRA L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 ANDERSON AVE SE
ALBUQUERQUE NM
87106-1612
US

IV. Provider business mailing address

3534 ANDERSON AVE. SE INNER GUIDANCE,
ALBUQUERQUE NM
87106-1512
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-0061
  • Fax: 505-237-0068
Mailing address:
  • Phone: 505-237-0061
  • Fax: 505-237-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-06584
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: