Provider Demographics
NPI:1891076410
Name:MORONEY, MARK D
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:MORONEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2948
Mailing Address - Country:US
Mailing Address - Phone:650-834-4340
Mailing Address - Fax:
Practice Address - Street 1:2560 PULGAS AVE
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1323
Practice Address - Country:US
Practice Address - Phone:650-325-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)