Provider Demographics
NPI:1932295839
Name:MOCHA, PAUL ALEXANDER (LICSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALEXANDER
Last Name:MOCHA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HOME
Mailing Address - Street 2:VA PUGET SOUND HEALTH CARE SYSTEM AMERICAN LAKE DIVISIO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493
Mailing Address - Country:US
Mailing Address - Phone:253-583-1739
Mailing Address - Fax:253-589-4067
Practice Address - Street 1:9600 VETERANS DRIVE SW
Practice Address - Street 2:VA PUGET SOUND HEALTH CARE SYSTEM BLDG 6 RM 132
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493
Practice Address - Country:US
Practice Address - Phone:253-583-1739
Practice Address - Fax:253-589-4067
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000058381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical