Provider Demographics
NPI:1215348693
Name:MORA, REBEKAH ALEXANDER (LCSW)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ALEXANDER
Last Name:MORA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1255 KENDALL RD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-8750
Mailing Address - Country:US
Mailing Address - Phone:805-302-1998
Mailing Address - Fax:805-503-6499
Practice Address - Street 1:1255 KENDALL RD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-8750
Practice Address - Country:US
Practice Address - Phone:805-302-1998
Practice Address - Fax:805-503-6499
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW724961041C0700X
CA72496104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical