Provider Demographics
NPI:1871718759
Name:MAGNELLI, BETHANY R (PSYD)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:R
Last Name:MAGNELLI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:RAINAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6713 INDIANA AVE
Mailing Address - Street 2:PMB #24
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4263
Mailing Address - Country:US
Mailing Address - Phone:951-756-2440
Mailing Address - Fax:
Practice Address - Street 1:630 E RIALTO AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1292
Practice Address - Country:US
Practice Address - Phone:909-386-0904
Practice Address - Fax:909-386-0912
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT41649106H00000X
CAPSY 22581103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist