Provider Demographics
NPI:1093961104
Name:HORTA MOSS, MAIRA (MFT)
Entity Type:Individual
Prefix:MS
First Name:MAIRA
Middle Name:
Last Name:HORTA MOSS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RUA DAS CAMELIAS 65
Mailing Address - Street 2:
Mailing Address - City:SAO PAULO
Mailing Address - State:SAO PAULO
Mailing Address - Zip Code:04048 060
Mailing Address - Country:BR
Mailing Address - Phone:001551199-885-8478
Mailing Address - Fax:858-775-8478
Practice Address - Street 1:2850 4TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6208
Practice Address - Country:US
Practice Address - Phone:858-775-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor