Healthcare Provider Details

I. General information

NPI: 1215939970
Provider Name (Legal Business Name): REBECCA MORALES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STONE PL STE 305
BRONXVILLE NY
10708-3427
US

IV. Provider business mailing address

1463 WARING AVE
BRONX NY
10469-5707
US

V. Phone/Fax

Practice location:
  • Phone: 917-304-5910
  • Fax:
Mailing address:
  • Phone: 917-304-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR056901-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: