Provider Demographics
NPI:1275778524
Name:BUENO, CECILIA BINGHAM (LMFT , LCDC)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:BINGHAM
Last Name:BUENO
Suffix:
Gender:F
Credentials:LMFT , LCDC
Other - Prefix:PROF
Other - First Name:CEE
Other - Middle Name:B
Other - Last Name:BUENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD (DPHIL), LMFT
Mailing Address - Street 1:310 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3620
Mailing Address - Country:US
Mailing Address - Phone:830-431-4777
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-539-9819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA89841106H00000X
TX89841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health