Provider Demographics
NPI:1720118078
Name:MOSES, EDNA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:L
Last Name:MOSES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 ROCOSO WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-1830
Mailing Address - Country:US
Mailing Address - Phone:805-683-6702
Mailing Address - Fax:805-683-6702
Practice Address - Street 1:674 COUNTY SQUARE DR
Practice Address - Street 2:SUITE 307
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5454
Practice Address - Country:US
Practice Address - Phone:805-683-6702
Practice Address - Fax:805-683-6702
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS11679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health