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General NPI Number Information
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NPI Number | 1922343540
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Entity Type | Individual
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Provider Name | JOSEPHINE MACIEL MORA
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Gender | Female
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 09/20/2017
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Provider Practice Location Address
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Address Line | 2648 INTERNATIONAL BLVD
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City | OAKLAND
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State | CA
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Zip | 94601-1506
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Country | US
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Telephone | 510-437-8955
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 OLYMPIC BLVD SUITE #210
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City | WALNUT CREEK
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State | CA
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Zip | 94596
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Country | US
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Telephone | 925-984-4463
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 100066
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License Number State | CA
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