MEDICARE: MS. SUSAN MORA LMHC, LPC

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	101YM0800X	Mental Health Counselor	009449	NY

General Provider Information

NPI Number	:	1366808925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MORA LMHC, LPC

Provider Business Mailing Address
First Line	:	20934 NORTHERN BLVD # 1069
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-3149
Country	:	US
Telephone Number	:	646-893-7540
Fax Number	:

Provider Business Practice Location Address
First Line	:	2628 93RD ST E
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11369
Country	:	US
Telephone Number	:	646-893-7540
Fax Number	:

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

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	09/11/2023

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