Provider Demographics
NPI:1326894932
Name:MCBRIDE, EDWIN JR (MDIV)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:MCBRIDE
Suffix:JR
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 LONGMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2298
Mailing Address - Country:US
Mailing Address - Phone:818-849-4103
Mailing Address - Fax:
Practice Address - Street 1:1850 N RIVERSIDE AVE STE 180
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8071
Practice Address - Country:US
Practice Address - Phone:949-393-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04192008101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral