Provider Demographics
NPI:1770810350
Name:MOYANO, LINA MARIA (EDD, LCSW)
Entity type:Individual
Prefix:DR
First Name:LINA
Middle Name:MARIA
Last Name:MOYANO
Suffix:
Gender:F
Credentials:EDD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3943
Mailing Address - Country:US
Mailing Address - Phone:954-232-0507
Mailing Address - Fax:954-357-1766
Practice Address - Street 1:3130 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3943
Practice Address - Country:US
Practice Address - Phone:954-232-0507
Practice Address - Fax:954-357-1766
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW96621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical