Provider Demographics
NPI:1528432085
Name:BARAJAS, AMY J (MFTI)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:AGUERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:931 LA PALMA CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7724
Mailing Address - Country:US
Mailing Address - Phone:909-260-2258
Mailing Address - Fax:
Practice Address - Street 1:1425 W FOOTHILL BLVD FL 3
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-8007
Practice Address - Country:US
Practice Address - Phone:909-303-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA113755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist