Provider Demographics
NPI:1720959828
Name:CERNOGG, SHAVEL YVETTE
Entity type:Individual
Prefix:
First Name:SHAVEL
Middle Name:YVETTE
Last Name:CERNOGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 BARTRAM TRL
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7367
Mailing Address - Country:US
Mailing Address - Phone:310-693-3391
Mailing Address - Fax:
Practice Address - Street 1:279 BARTRAM TRL
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-7367
Practice Address - Country:US
Practice Address - Phone:310-693-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-13
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9LHF896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health