Healthcare Provider Details

I. General information

NPI: 1518199678
Provider Name (Legal Business Name): FERMAN ULIBARRI LMSW, LSAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LETTON DR
RATON NM
87740-4366
US

IV. Provider business mailing address

101 LETTON DR
RATON NM
87740-4366
US

V. Phone/Fax

Practice location:
  • Phone: 575-445-8568
  • Fax: 575-445-0540
Mailing address:
  • Phone: 575-445-8568
  • Fax: 575-445-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0090011
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-4177
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: