Provider Demographics
NPI:1912199142
Name:MOISENCO, CHRISTINE (MFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MOISENCO
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 1:20212 REDWOOD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4324
Mailing Address - Country:US
Mailing Address - Phone:510-888-2080
Mailing Address - Fax:
Practice Address - Street 1:20212 REDWOOD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4324
Practice Address - Country:US
Practice Address - Phone:510-888-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist