Healthcare Provider Details

I. General information

NPI: 1104226950
Provider Name (Legal Business Name): DANIEL MORALES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 BROADWAY
NEW YORK NY
10012-3351
US

IV. Provider business mailing address

1382 SHAKESPEARE AVE APT 5K
BRONX NY
10452-1878
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-9537
  • Fax:
Mailing address:
  • Phone: 917-807-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081910
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: