Provider Demographics
NPI:1437254687
Name:MORALES, MILCIADES SEGUNDO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MILCIADES
Middle Name:SEGUNDO
Last Name:MORALES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 BUCHANAN ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2942
Mailing Address - Country:US
Mailing Address - Phone:925-783-0612
Mailing Address - Fax:925-439-5623
Practice Address - Street 1:2225 BUCHANAN ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2942
Practice Address - Country:US
Practice Address - Phone:925-783-0612
Practice Address - Fax:925-439-5623
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS6187104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MMM00291MMedicare ID - Type Unspecified