Provider Demographics
NPI:1558612556
Name:MOCQUANT, UBALDINA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:UBALDINA
Middle Name:
Last Name:MOCQUANT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 W PARMER LN
Mailing Address - Street 2:STE 370, #3064
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727
Mailing Address - Country:US
Mailing Address - Phone:512-387-6380
Mailing Address - Fax:512-957-2663
Practice Address - Street 1:6001 W PARMER LN
Practice Address - Street 2:STE 370, #3064
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727
Practice Address - Country:US
Practice Address - Phone:512-387-6380
Practice Address - Fax:512-957-2663
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-28276103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst