Provider Demographics
NPI:1871720813
Name:IBRAHIMI, ANTOINETTE MARIE KATHOL (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:MARIE KATHOL
Last Name:IBRAHIMI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5501
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91117-0501
Mailing Address - Country:US
Mailing Address - Phone:626-818-8327
Mailing Address - Fax:
Practice Address - Street 1:411 N INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4614
Practice Address - Country:US
Practice Address - Phone:626-470-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health