MEDICARE: MRS. MADELINE MORALES MS

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	103T00000X	Psychologist	000980	PR

General Provider Information

NPI Number	:	1457591984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADELINE MORALES MS

Provider Business Mailing Address
First Line	:	CONDOMINIO SKY TOWER 1 APTO. 15 B CALLE HORTENSIA
Second Line	:
City	:	SAN JUAN
State	:	PUERTO RICO
Zip	:	00926
Country	:	UM
Telephone Number	:	787-568-6979
Fax Number	:	787-706-7945

Provider Business Practice Location Address
First Line	:	1324 CALLE CANADA
Second Line	:	DE DIEGO AVENUE
City	:	SAN JUAN
State	:	PUERTO RICO
Zip	:	00928-1414
Country	:	UM
Telephone Number	:	787-793-1828
Fax Number	:	787-706-7945

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

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	02/24/2009

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