Provider Demographics
NPI:1578774733
Name:BRAD STENBERG, D.MFT.
Entity Type:Organization
Organization Name:BRAD STENBERG, D.MFT.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-716-2489
Mailing Address - Street 1:170 W SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2435
Mailing Address - Country:US
Mailing Address - Phone:626-716-2489
Mailing Address - Fax:626-355-0512
Practice Address - Street 1:156 W SIERRA MADRE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2435
Practice Address - Country:US
Practice Address - Phone:626-716-2489
Practice Address - Fax:626-355-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33201261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)