Provider Demographics
NPI:1326406513
Name:CISNEROS JUAREZ, ADILENE (MASTERS)
Entity type:Individual
Prefix:
First Name:ADILENE
Middle Name:
Last Name:CISNEROS JUAREZ
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E BETTERAVIA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8803
Mailing Address - Country:US
Mailing Address - Phone:805-465-2553
Mailing Address - Fax:
Practice Address - Street 1:411 E BETTERAVIA RD STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8803
Practice Address - Country:US
Practice Address - Phone:805-465-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12010101Y00000X
CA3272101YM0800X
CA15104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health