MEDICARE: CARLY J MORAN

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1750727905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY J MORAN

Provider Business Mailing Address
First Line	:	502 6TH BAXTER XING # B
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6596
Country	:	US
Telephone Number	:	832-904-3822
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 6TH BAXTER XING # B
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6596
Country	:	US
Telephone Number	:	832-904-3822
Fax Number	:

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

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	05/06/2025

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