Provider Demographics
NPI:1902641061
Name:DAVALOS, MORAIMA (LCSW)
Entity type:Individual
Prefix:
First Name:MORAIMA
Middle Name:
Last Name:DAVALOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 CARMEL WAY
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-5784
Mailing Address - Country:US
Mailing Address - Phone:951-663-7449
Mailing Address - Fax:
Practice Address - Street 1:441 CARMEL WAY
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-5784
Practice Address - Country:US
Practice Address - Phone:951-663-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW847161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical