Provider Demographics
NPI:1053867341
Name:BARENBOIM, HERNAN E (PHD, LMFT)
Entity Type:Individual
Prefix:
First Name:HERNAN
Middle Name:E
Last Name:BARENBOIM
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N SAN JACINTO ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3119
Mailing Address - Country:US
Mailing Address - Phone:951-766-6460
Mailing Address - Fax:
Practice Address - Street 1:301 N SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3119
Practice Address - Country:US
Practice Address - Phone:951-766-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1215106H00000X
MO2016016755106H00000X
IL166001063106H00000X
IN35001930A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053867341Medicaid