Provider Demographics
NPI:1194931956
Name:KIRSHBAUM, BARBARA JO (MFT)
Entity type:Individual
Prefix:MRS
First Name:BARBARA JO
Middle Name:
Last Name:KIRSHBAUM
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 1:8283 GROVE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3137
Mailing Address - Country:US
Mailing Address - Phone:909-985-4767
Mailing Address - Fax:909-981-5048
Practice Address - Street 1:8283 GROVE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3137
Practice Address - Country:US
Practice Address - Phone:909-985-4767
Practice Address - Fax:909-981-5048
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist