Healthcare Provider Details

I. General information

NPI: 1760874614
Provider Name (Legal Business Name): ELENA JULIA MORALES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LAUREL AVE SUITE 290
CORNWALL NY
12518-1469
US

IV. Provider business mailing address

3250 US ROUTE 9W
NEW WINDSOR NY
12553-6756
US

V. Phone/Fax

Practice location:
  • Phone: 845-551-2323
  • Fax: 845-458-4559
Mailing address:
  • Phone: 845-562-9816
  • Fax: 845-863-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: