Provider Demographics
NPI:1780138388
Name:TAKEUCHI VENEGAS, CERIN (ACSW)
Entity type:Individual
Prefix:
First Name:CERIN
Middle Name:
Last Name:TAKEUCHI VENEGAS
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5932
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-8031
Mailing Address - Country:US
Mailing Address - Phone:951-415-5858
Mailing Address - Fax:
Practice Address - Street 1:41689 ENTERPRISE CIR N STE 120
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5630
Practice Address - Country:US
Practice Address - Phone:951-587-4165
Practice Address - Fax:951-587-4297
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1186481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical