Healthcare Provider Details

I. General information

NPI: 1144640657
Provider Name (Legal Business Name): LISA MORAZES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3191 HARBOR BLVD STE A
PORT CHARLOTTE FL
33952-6755
US

IV. Provider business mailing address

22075 MALONE AVE
PORT CHARLOTTE FL
33952-7024
US

V. Phone/Fax

Practice location:
  • Phone: 941-883-4518
  • Fax: 941-391-5975
Mailing address:
  • Phone: 941-204-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: