Healthcare Provider Details

I. General information

NPI: 1881838498
Provider Name (Legal Business Name): CARLOS MANUEL MORALES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

796H DREW ST
BROOKLYN NY
11208-4704
US

IV. Provider business mailing address

588 GRAND BLVD
DEER PARK NY
11729-5320
US

V. Phone/Fax

Practice location:
  • Phone: 718-235-3100
  • Fax: 718-277-0822
Mailing address:
  • Phone: 631-455-4315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00072916
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: