Provider Demographics
NPI:1811061880
Name:DAVIDSON CIBELLI, CHERILYN ELAINE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERILYN
Middle Name:ELAINE
Last Name:DAVIDSON CIBELLI
Suffix:
Gender:F
Credentials:PHD
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 306
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0101
Mailing Address - Country:US
Mailing Address - Phone:951-317-0243
Mailing Address - Fax:951-769-4079
Practice Address - Street 1:1325 S AUTO PLAZA DR
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2762
Practice Address - Country:US
Practice Address - Phone:951-317-0243
Practice Address - Fax:951-769-4079
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16474103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent