Provider Demographics
NPI:1174834725
Name:MABERRY, RAYMOND L
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:L
Last Name:MABERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MOUNTAIN AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5177
Mailing Address - Country:US
Mailing Address - Phone:909-303-3315
Mailing Address - Fax:
Practice Address - Street 1:1206 W 14TH ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2517
Practice Address - Country:US
Practice Address - Phone:909-360-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor