Provider Demographics
NPI:1679272256
Name:BANUELOS, CRISTIAN P (LCSW)
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:P
Last Name:BANUELOS
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 1:9724 SPRY ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3110
Mailing Address - Country:US
Mailing Address - Phone:562-904-3582
Mailing Address - Fax:
Practice Address - Street 1:9724 SPRY ST
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3110
Practice Address - Country:US
Practice Address - Phone:562-904-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA883051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical