Provider Demographics
NPI:1649864224
Name:HARO GUADARRAMA, GERARDO (AMFT)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:HARO GUADARRAMA
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2468 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-1122
Mailing Address - Country:US
Mailing Address - Phone:909-953-4477
Mailing Address - Fax:909-501-0832
Practice Address - Street 1:850 E FOOTHILL BLVD STE E
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9249
Practice Address - Fax:909-421-9466
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9655101YA0400X
CAAMFT119046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty