Healthcare Provider Details

I. General information

NPI: 1790220911
Provider Name (Legal Business Name): MAYELIN MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2016
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92300 OVERSEAS HWY STE 302
TAVERNIER FL
33070-2726
US

IV. Provider business mailing address

1530 SW 150TH AVE
MIAMI FL
33194-2540
US

V. Phone/Fax

Practice location:
  • Phone: 305-975-3126
  • Fax:
Mailing address:
  • Phone: 305-975-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW14143
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2831848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: