Provider Demographics
NPI:1477707503
Name:MORALES, AMANDA J (LCSW 27881)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:J
Last Name:MORALES
Suffix:
Gender:F
Credentials:LCSW 27881
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:5060 SHOREHAM PL STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5976
Mailing Address - Country:US
Mailing Address - Phone:877-840-6956
Mailing Address - Fax:619-383-6701
Practice Address - Street 1:5060 SHOREHAM PL STE 330
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5976
Practice Address - Country:US
Practice Address - Phone:877-840-6956
Practice Address - Fax:619-383-6701
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7544Medicaid