Healthcare Provider Details

I. General information

NPI: 1811061880
Provider Name (Legal Business Name): CHERILYN ELAINE DAVIDSON CIBELLI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S AUTO PLAZA DR SUITE 130
SAN BERNARDINO CA
92408-2762
US

IV. Provider business mailing address

PO BOX 306
REDLANDS CA
92373-0101
US

V. Phone/Fax

Practice location:
  • Phone: 951-317-0243
  • Fax: 951-769-4079
Mailing address:
  • Phone: 951-317-0243
  • Fax: 951-769-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY16474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: