Provider Demographics
NPI:1013571116
Name:MOUSA, MARIA EDWARD (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:EDWARD
Last Name:MOUSA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24438 SANTA CLARA ST
Mailing Address - Street 2:POBOX 3254
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-9998
Mailing Address - Country:US
Mailing Address - Phone:949-407-9354
Mailing Address - Fax:
Practice Address - Street 1:26172 REGAL AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-3102
Practice Address - Country:US
Practice Address - Phone:949-836-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist