Provider Demographics
NPI:1417370420
Name:MISURACA, MATTHEW DONALD (MA, LMFT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DONALD
Last Name:MISURACA
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74133 EL PASEO
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4119
Mailing Address - Country:US
Mailing Address - Phone:760-708-8253
Mailing Address - Fax:760-779-5600
Practice Address - Street 1:74133 EL PASEO
Practice Address - Street 2:SUITE 11
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4119
Practice Address - Country:US
Practice Address - Phone:760-708-8253
Practice Address - Fax:760-779-5600
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 53014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist