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General NPI Number Information
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NPI Number | 1902350838
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Entity Type | Individual
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Provider Name | SANDRA IBANEZ MHC
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Gender | Female
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 09/19/2017
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Provider Practice Location Address
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Address Line | 1601 NW 12TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 786-208-5327
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Fax |
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Provider Business Mailing Address
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Address Line | 16057 SW 85TH ST
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City | MIAMI
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State | FL
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Zip | 33193-3078
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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