Provider Demographics
NPI:1588936009
Name:MOCCARDINI, KEVIN A (MFC 50540)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:MOCCARDINI
Suffix:
Gender:M
Credentials:MFC 50540
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44709 N. DATE AVE.
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-802-9401
Mailing Address - Fax:661-942-5195
Practice Address - Street 1:44709 N. DATE AVE.
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-802-9401
Practice Address - Fax:661-942-5195
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT50540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist