Provider Demographics
NPI:1710066451
Name:CHERBOWSKY, JOSE (MFT)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:CHERBOWSKY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11772 SORRENTO VALLEY RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1015
Mailing Address - Country:US
Mailing Address - Phone:760-420-4971
Mailing Address - Fax:760-230-8016
Practice Address - Street 1:11772 SORRENTO VALLEY RD
Practice Address - Street 2:SUITE 160
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1015
Practice Address - Country:US
Practice Address - Phone:760-420-4971
Practice Address - Fax:760-230-8016
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist