Provider Demographics
NPI:1972238368
Name:MOONEY, MARQUITA
Entity Type:Individual
Prefix:MRS
First Name:MARQUITA
Middle Name:
Last Name:MOONEY
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 1:87-1980 PAKEKE ST APT L
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3497
Mailing Address - Country:US
Mailing Address - Phone:931-538-2109
Mailing Address - Fax:
Practice Address - Street 1:87-1980 PAKEKE ST APT L
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3497
Practice Address - Country:US
Practice Address - Phone:931-538-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-2914104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker