MEDICARE: MINOA BEHAVIORAL SERVICES LLC

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1316870389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINOA BEHAVIORAL SERVICES LLC

Provider Business Mailing Address
First Line	:	252 EMERSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-3115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 EMERSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-3115
Country	:	US
Telephone Number	:	347-422-4364
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	JELMY MORALES
Credential	:
Telephone Number	:	347-422-4364

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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