Healthcare Provider Details

I. General information

NPI: 1215153275
Provider Name (Legal Business Name): OLGA MORA-ALDRICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLGA MORA

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 ROUTE 73 STE 300
MOUNT LAUREL NJ
08054-5113
US

IV. Provider business mailing address

10 CALLE CASIA PSYCHIATRY DEPARTMENT
SAN JUAN PR
00921-3200
US

V. Phone/Fax

Practice location:
  • Phone: 800-442-8938
  • Fax:
Mailing address:
  • Phone: 787-641-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA99903
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA99903
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: