Provider Demographics
NPI:1992913651
Name:BARE, CHRISTINE HUNTINGTON (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:HUNTINGTON
Last Name:BARE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55176
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91385
Mailing Address - Country:US
Mailing Address - Phone:661-259-9691
Mailing Address - Fax:661-259-3331
Practice Address - Street 1:23733 VIA LUPONA
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-259-9691
Practice Address - Fax:661-259-3331
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19010103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP19010Medicare ID - Type Unspecified