Healthcare Provider Details

I. General information

NPI: 1235838145
Provider Name (Legal Business Name): MARIA MOYA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 SW 156TH AVE
MIRAMAR FL
33027-4277
US

IV. Provider business mailing address

2591 SW 156TH AVE
MIRAMAR FL
33027-4277
US

V. Phone/Fax

Practice location:
  • Phone: 954-821-5472
  • Fax:
Mailing address:
  • Phone: 954-821-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: