Provider Demographics
NPI:1316662729
Name:DIBS, MARIA ELISABETH
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELISABETH
Last Name:DIBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 EDISON AVE APT 87
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2454
Mailing Address - Country:US
Mailing Address - Phone:707-774-5717
Mailing Address - Fax:
Practice Address - Street 1:2829 WATT AVE STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-6245
Practice Address - Country:US
Practice Address - Phone:916-418-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1265721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical