Provider Demographics
NPI:1174785083
Name:MOANEY, LUCINDA J (MC/MFCT)
Entity type:Individual
Prefix:MS
First Name:LUCINDA
Middle Name:J
Last Name:MOANEY
Suffix:
Gender:F
Credentials:MC/MFCT
Other - Prefix:
Other - First Name:LUCINDA
Other - Middle Name:MOANEY
Other - Last Name:PARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4802 LANTANA DR APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-2962
Mailing Address - Country:US
Mailing Address - Phone:619-379-1353
Mailing Address - Fax:
Practice Address - Street 1:4283 EL CAJON BLVD
Practice Address - Street 2:STE. 115
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1289
Practice Address - Country:US
Practice Address - Phone:619-521-1743
Practice Address - Fax:619-521-1896
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55789106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist