Healthcare Provider Details

I. General information

NPI: 1619718590
Provider Name (Legal Business Name): NATALIE MOY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 ORANGE ST
RIVERSIDE CA
92501-3829
US

IV. Provider business mailing address

3400 CENTRAL AVE STE 235
RIVERSIDE CA
92506-2175
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-6335
  • Fax:
Mailing address:
  • Phone: 951-781-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: