Healthcare Provider Details

I. General information

NPI: 1659295871
Provider Name (Legal Business Name): BRYAN CAFFERKY LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E CITRUS AVE
REDLANDS CA
92373-4747
US

IV. Provider business mailing address

34218 FOREST OAKS DR
YUCAIPA CA
92399-6924
US

V. Phone/Fax

Practice location:
  • Phone: 909-328-6179
  • Fax:
Mailing address:
  • Phone: 630-433-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: