Provider Demographics
NPI:1578898896
Name:MOREA, SUSAN M (MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MOREA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5776 STONERIDGE MALL RD STE 140
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2833
Mailing Address - Country:US
Mailing Address - Phone:925-734-8772
Mailing Address - Fax:925-467-1497
Practice Address - Street 1:5776 STONERIDGE MALL RD STE 140
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2833
Practice Address - Country:US
Practice Address - Phone:925-734-8772
Practice Address - Fax:925-467-1497
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-04
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist