Healthcare Provider Details

I. General information

NPI: 1093243990
Provider Name (Legal Business Name): EBONI D MORAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 3113
TORRANCE CA
90510-3113
US

IV. Provider business mailing address

PO BOX 3113
TORRANCE CA
90510-3113
US

V. Phone/Fax

Practice location:
  • Phone: 310-704-5197
  • Fax:
Mailing address:
  • Phone: 310-704-5197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23895
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: