Provider Demographics
NPI:1215484399
Name:MUSARACA, CONNIE MAE
Entity type:Individual
Prefix:MISS
First Name:CONNIE
Middle Name:MAE
Last Name:MUSARACA
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 1:8775 AERO DR STE 132
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1779
Mailing Address - Country:US
Mailing Address - Phone:858-609-8742
Mailing Address - Fax:858-292-0322
Practice Address - Street 1:CITY STAR ACT / MHS
Practice Address - Street 2:8775 AERO DRIVE, SUITE 132
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1779
Practice Address - Country:US
Practice Address - Phone:858-609-8742
Practice Address - Fax:858-292-0322
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)