Provider Demographics
NPI:1962875013
Name:STYLIANIDES, DENISE (MA)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:STYLIANIDES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:PALENZUELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 SENTINEL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3280
Mailing Address - Country:US
Mailing Address - Phone:909-593-2581
Mailing Address - Fax:909-596-3567
Practice Address - Street 1:1025 SENTINEL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3280
Practice Address - Country:US
Practice Address - Phone:909-593-2581
Practice Address - Fax:909-596-3567
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7565AOtherOUTPATIENT MENTAL HEALTH