Provider Demographics
NPI:1215001607
Name:MOSES, MABEL NONE (LCSW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:MABEL
Middle Name:NONE
Last Name:MOSES
Suffix:
Gender:F
Credentials:LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4548 IMPERIAL WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-9386
Mailing Address - Country:US
Mailing Address - Phone:925-813-4257
Mailing Address - Fax:
Practice Address - Street 1:4548 IMPERIAL WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-9386
Practice Address - Country:US
Practice Address - Phone:925-813-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS144511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical