Provider Demographics
NPI:1053798066
Name:STENBERG, BRADLEY A (DMFT)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:STENBERG
Suffix:
Gender:M
Credentials:DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2435
Mailing Address - Country:US
Mailing Address - Phone:626-716-2489
Mailing Address - Fax:626-355-0512
Practice Address - Street 1:156 W SIERRA MADRE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2435
Practice Address - Country:US
Practice Address - Phone:626-716-2489
Practice Address - Fax:626-355-0512
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist