Healthcare Provider Details

I. General information

NPI: 1891409934
Provider Name (Legal Business Name): MARIE HELENE MOREAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 BRUTON BLVD STE A
ORLANDO FL
32805-6608
US

IV. Provider business mailing address

5526 LIMESTONE ST
MOUNT DORA FL
32757-8058
US

V. Phone/Fax

Practice location:
  • Phone: 407-514-4470
  • Fax:
Mailing address:
  • Phone: 407-373-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: