Provider Demographics
NPI:1992892939
Name:MOSKOWITZ, MARILYN AUDREY (MFT LCSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:AUDREY
Last Name:MOSKOWITZ
Suffix:
Gender:F
Credentials:MFT LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1203
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-1203
Mailing Address - Country:US
Mailing Address - Phone:760-356-0068
Mailing Address - Fax:760-352-5422
Practice Address - Street 1:300 S IMPERIAL AVE STE 6
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92273
Practice Address - Country:US
Practice Address - Phone:760-356-0068
Practice Address - Fax:760-352-5422
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS113751041C0700X
CAMFT16488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist