Provider Demographics
NPI:1013927615
Name:SERRANO, RAPHAEL CLEMENTE (LMFT LICENSED MARRIG)
Entity Type:Individual
Prefix:MR
First Name:RAPHAEL
Middle Name:CLEMENTE
Last Name:SERRANO
Suffix:
Gender:M
Credentials:LMFT LICENSED MARRIG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MOBIL AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6344
Mailing Address - Country:US
Mailing Address - Phone:805-448-7732
Mailing Address - Fax:805-482-3762
Practice Address - Street 1:401 MOBIL AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6344
Practice Address - Country:US
Practice Address - Phone:805-448-7732
Practice Address - Fax:805-482-3762
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist