Provider Demographics
NPI:1508210790
Name:HERNANDEZ-MORALES, MAYRA (AMFT)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:HERNANDEZ-MORALES
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 MARENGO ST. SUITE #107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-276-6490
Mailing Address - Fax:323-276-6481
Practice Address - Street 1:1902 MARENGO ST. SUITE #107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-276-6490
Practice Address - Fax:323-276-6481
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X, 390200000X
CAAMFT116245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program