Provider Demographics
NPI:1003922089
Name:MORRERA, GEORGE (PHD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MORRERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 ERRINGER RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6508
Mailing Address - Country:US
Mailing Address - Phone:805-527-1010
Mailing Address - Fax:805-493-1067
Practice Address - Street 1:1687 ERRINGER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6508
Practice Address - Country:US
Practice Address - Phone:805-527-1010
Practice Address - Fax:805-493-1067
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPS4106820Medicaid
CAPS4106820Medicaid