Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ASW61888 | CA |
Y | 1041C0700X | Clinical Social Worker | 99435 | CA |
NPI | 1003211764 |
---|---|
Provider Name | Ana Moran |
First Address | Los Angeles, CA 90017-1466 |
Second Address | Los Angeles, CA 90017-1466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2014 |
Last Update Date | 15/01/2021 |