Provider Demographics
NPI:1891819223
Name:MORET, CANDACE YVETTE
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:YVETTE
Last Name:MORET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 W 61ST ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-3749
Mailing Address - Country:US
Mailing Address - Phone:323-855-2661
Mailing Address - Fax:
Practice Address - Street 1:4618 FOUNTAIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1963
Practice Address - Country:US
Practice Address - Phone:323-644-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical