Provider Demographics
NPI:1790327229
Name:MISURACA, MAUREEN PAULA (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:PAULA
Last Name:MISURACA
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49211 GRAPEFRUIT BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1480
Mailing Address - Country:US
Mailing Address - Phone:760-541-8520
Mailing Address - Fax:760-262-3795
Practice Address - Street 1:49211 GRAPEFRUIT BLVD STE 6
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1480
Practice Address - Country:US
Practice Address - Phone:760-541-8520
Practice Address - Fax:760-262-3795
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10069892106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist