Healthcare Provider Details

I. General information

NPI: 1033407366
Provider Name (Legal Business Name): MS. JOANNE MARIE MORREALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 N MOUNTAIN AVE
CLAREMONT CA
91711-1586
US

IV. Provider business mailing address

2243 N MOUNTAIN AVE
CLAREMONT CA
91711-1586
US

V. Phone/Fax

Practice location:
  • Phone: 909-447-5346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number76339
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: