Provider Demographics
NPI:1497900385
Name:CRIPPEN, BEVERLY JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JEAN
Last Name:CRIPPEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 E ROUTE 66
Mailing Address - Street 2:SUITE E
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3747
Mailing Address - Country:US
Mailing Address - Phone:909-456-0460
Mailing Address - Fax:
Practice Address - Street 1:425 W BONITA AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2543
Practice Address - Country:US
Practice Address - Phone:909-456-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS230051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical