Provider Demographics
NPI:1689361727
Name:BRONSON, KENNETH BYRON (CADCII)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BYRON
Last Name:BRONSON
Suffix:
Gender:M
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1639
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-1639
Mailing Address - Country:US
Mailing Address - Phone:714-742-9288
Mailing Address - Fax:909-388-6060
Practice Address - Street 1:1100 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3524
Practice Address - Country:US
Practice Address - Phone:909-884-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)