Provider Demographics
NPI:1073157657
Name:CERVANTES, CHRIS RIO (ASW 92272)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:RIO
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:ASW 92272
Other - Prefix:
Other - First Name:YESENIA
Other - Middle Name:CHRISTINE
Other - Last Name:MENENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW 92272
Mailing Address - Street 1:3350 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 S SAN PEDRO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2102
Practice Address - Country:US
Practice Address - Phone:323-201-4516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW92272101YM0800X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker