Healthcare Provider Details

I. General information

NPI: 1649355769
Provider Name (Legal Business Name): CHERRLYNN MONEAKA HUBBARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MACKAY DR STE 100
SAN BERNARDINO CA
92408-3222
US

IV. Provider business mailing address

2020 IOWA AVE STE 101
RIVERSIDE CA
92507-7428
US

V. Phone/Fax

Practice location:
  • Phone: 909-433-9300
  • Fax: 909-433-9308
Mailing address:
  • Phone: 951-384-4699
  • Fax: 951-384-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: