Provider Demographics
NPI:1427079573
Name:IBOLD, LORRAINE (LCSW)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:IBOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:PEREZ-IBOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:505 N TUSTIN AVE STE 134
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3712
Mailing Address - Country:US
Mailing Address - Phone:714-541-4921
Mailing Address - Fax:714-541-4925
Practice Address - Street 1:505 N TUSTIN AVE STE 134
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3712
Practice Address - Country:US
Practice Address - Phone:714-541-4921
Practice Address - Fax:714-541-4925
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS223781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical