Provider Demographics
NPI:1659407096
Name:COUNTY OF SAN BERNARDINO DEPT OF BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:COUNTY OF SAN BERNARDINO DEPT OF BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST II
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VERDUGO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-421-9338
Mailing Address - Street 1:12294 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6814
Mailing Address - Country:US
Mailing Address - Phone:909-485-4952
Mailing Address - Fax:
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health