1881656486 NPI number — MRS. MAYTE IDELLE GIUBARDO LCSW

Table of content: MRS. MAYTE IDELLE GIUBARDO LCSW (NPI 1881656486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881656486 NPI number — MRS. MAYTE IDELLE GIUBARDO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIUBARDO
Provider First Name:
MAYTE
Provider Middle Name:
IDELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881656486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1743 SYCAMORE AVE
Provider Second Line Business Mailing Address:
MOHAVE MENTAL HEALTH CLINIC INC
Provider Business Mailing Address City Name:
KINGMAN
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-757-8111
Provider Business Mailing Address Fax Number:
928-757-3256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 MARINA BLVD
Provider Second Line Business Practice Location Address:
MOHAVE MENTAL HEALTH CLINIC INC
Provider Business Practice Location Address City Name:
BULLHEAD CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-758-5905
Provider Business Practice Location Address Fax Number:
928-757-3256
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW11855 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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