Healthcare Provider Details

I. General information

NPI: 1023896909
Provider Name (Legal Business Name): MORA SPICER II LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MORA SPICER II LCSW

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10634 S NORMAL AVE
CHICAGO IL
60628-2432
US

IV. Provider business mailing address

12520 S STEWART AVE
CHICAGO IL
60628-7231
US

V. Phone/Fax

Practice location:
  • Phone: 404-720-4056
  • Fax:
Mailing address:
  • Phone: 404-720-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: