Healthcare Provider Details

I. General information

NPI: 1497277941
Provider Name (Legal Business Name): JUAN CARLOS MOREL JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUAN CARLOS MOREL JR. MSW

II. Dates (important events)

Enumeration Date: 07/15/2017
Last Update Date: 07/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 GRAND CONCOURSE # 1DE
BRONX NY
10458-2611
US

IV. Provider business mailing address

312 65TH ST
WEST NEW YORK NJ
07093-2312
US

V. Phone/Fax

Practice location:
  • Phone: 347-577-5844
  • Fax:
Mailing address:
  • Phone: 201-688-9841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: