Provider Demographics
NPI:1124343538
Name:HOWARD CORNWELL, CINNAMON (MFT)
Entity type:Individual
Prefix:
First Name:CINNAMON
Middle Name:
Last Name:HOWARD CORNWELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 304-A
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2757
Mailing Address - Country:US
Mailing Address - Phone:310-770-5775
Mailing Address - Fax:
Practice Address - Street 1:2200 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 304-A
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2757
Practice Address - Country:US
Practice Address - Phone:310-770-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist