Individual provider · NPI-1

Sandra Ibanez, MHC

Developmental Therapist · Miami, FL

NPI number1902350838
StatusActive
Last updated in NPPESSep 19, 2017

Details

NPI
1902350838
Entity type
Individual (NPI-1)
Name
Sandra Ibanez
Credential
MHC
Sex
Female
Sole proprietor
Yes
Enumeration date
Aug 9, 2016
Last updated
Sep 19, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
222Q00000X Developmental Therapist––Yes
101YM0800X Counselor, Mental Health––
225C00000X Rehabilitation Counselor––

Practice location

1601 Nw 12th Ave
Miami, FL 33136-1005

Phone 786-208-5327

Mailing address

16057 Sw 85th St
Miami, FL 33193-3078

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