Provider Demographics
NPI:1407085392
Name:VIDAL, MARIA NOEMI (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:NOEMI
Last Name:VIDAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:NOEMI
Other - Last Name:ORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:425 ARMSTRONG DR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-2406
Mailing Address - Country:US
Mailing Address - Phone:714-524-3487
Mailing Address - Fax:
Practice Address - Street 1:2024 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2623
Practice Address - Country:US
Practice Address - Phone:714-906-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41848106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist