Provider Demographics
NPI:1609647825
Name:SELENA BRIANA BUENO LCSW A PROF CORP
Entity Type:Organization
Organization Name:SELENA BRIANA BUENO LCSW A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:BRIANA
Authorized Official - Last Name:BUENO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-544-1492
Mailing Address - Street 1:17130 VAN BUREN BLVD
Mailing Address - Street 2:PMB 620
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-5905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4158 ROSEWOOD PL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1757
Practice Address - Country:US
Practice Address - Phone:909-544-1492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty