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General NPI Number Information
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NPI Number | 1609647825
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Entity Type | Organization
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Legal Business Name | SELENA BRIANA BUENO LCSW A PROF CORP
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 4158 ROSEWOOD PL
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City | RIVERSIDE
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State | CA
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Zip | 92506-1757
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Country | US
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Telephone | 909-544-1492
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Fax |
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Provider Business Mailing Address
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Address Line | 17130 VAN BUREN BLVD PMB 620
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City | RIVERSIDE
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State | CA
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Zip | 92504-5905
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SELENA BRIANA BUENO
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Credential | LCSW
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Telephone | 909-544-1492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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