Provider Demographics
NPI:1346572245
Name:CAINES, AGENA
Entity Type:Individual
Prefix:MRS
First Name:AGENA
Middle Name:
Last Name:CAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AGENA
Other - Middle Name:ANDREE
Other - Last Name:CAINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1802 COMMERCENTER W
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3333
Mailing Address - Country:US
Mailing Address - Phone:909-386-0335
Mailing Address - Fax:
Practice Address - Street 1:1802 COMMERCENTER W
Practice Address - Street 2:SUITE B
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3333
Practice Address - Country:US
Practice Address - Phone:909-386-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health