Provider Demographics
NPI:1568952984
Name:MORETTI, MARY PATRICIA FITZGERALD (RADT-1 #RT1239380916)
Entity Type:Individual
Prefix:
First Name:MARY PATRICIA
Middle Name:FITZGERALD
Last Name:MORETTI
Suffix:
Gender:F
Credentials:RADT-1 #RT1239380916
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3380 G ST APT B
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0901
Mailing Address - Country:US
Mailing Address - Phone:209-347-0674
Mailing Address - Fax:
Practice Address - Street 1:559 MENDOCINO CT
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-4230
Practice Address - Country:US
Practice Address - Phone:209-357-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)