Provider Demographics
NPI:1023137106
Name:BERMUDEZ, ROBERT STANLEY JR (MA LMFT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STANLEY
Last Name:BERMUDEZ
Suffix:JR
Gender:M
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-1473
Mailing Address - Country:US
Mailing Address - Phone:951-765-6955
Mailing Address - Fax:
Practice Address - Street 1:930 N STATE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1473
Practice Address - Country:US
Practice Address - Phone:951-765-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53457106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist