Provider Demographics
NPI:1083810931
Name:SEIBERLING, MARK RAYMOND (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:RAYMOND
Last Name:SEIBERLING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 VIA MARIA BUENA
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3638
Mailing Address - Country:US
Mailing Address - Phone:951-684-6716
Mailing Address - Fax:
Practice Address - Street 1:5225 CANYON CREST DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6301
Practice Address - Country:US
Practice Address - Phone:951-248-4000
Practice Address - Fax:951-248-4021
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 84731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical