MEDICARE: MS. DAVIDA DELORES MORALES MSW, LGSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	23597	NY

General Provider Information

NPI Number	:	1215477781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAVIDA DELORES MORALES MSW, LGSW

Provider Business Mailing Address
First Line	:	3300 COUNTY ROAD 10
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55429-3072
Country	:	US
Telephone Number	:	952-452-0605
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 COUNTY ROAD 10
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55429-3072
Country	:	US
Telephone Number	:	952-452-0605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	03/03/2017

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