Provider Demographics
NPI:1649541368
Name:BRIONES, STANLEY CERDA (MFT INTERN)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:CERDA
Last Name:BRIONES
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12360 DELPHEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2202
Mailing Address - Country:US
Mailing Address - Phone:909-223-3837
Mailing Address - Fax:
Practice Address - Street 1:12322 CLEARGLEN AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-3872
Practice Address - Country:US
Practice Address - Phone:565-319-5549
Practice Address - Fax:562-943-5065
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF75038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist