Provider Demographics
NPI:1417350091
Name:SERNA, SILVIA IRIS (LMFT)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:IRIS
Last Name:SERNA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SILVIA
Other - Middle Name:IRIS
Other - Last Name:CARABALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTI
Mailing Address - Street 1:9479 HAVEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-771-8023
Mailing Address - Fax:909-989-0606
Practice Address - Street 1:9479 HAVEN AVENUE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-771-8023
Practice Address - Fax:909-989-0606
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF74081106H00000X
CA97863106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist