Provider Demographics
NPI:1841690963
Name:STAMENKOVIC, VERA (MS MFCC)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:STAMENKOVIC
Suffix:
Gender:F
Credentials:MS MFCC
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 1145
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92502-1145
Mailing Address - Country:US
Mailing Address - Phone:951-683-6322
Mailing Address - Fax:
Practice Address - Street 1:4192 BROCKTON AVE STE 202
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3430
Practice Address - Country:US
Practice Address - Phone:951-683-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist