Healthcare Provider Details

I. General information

NPI: 1922556257
Provider Name (Legal Business Name): LUZ ELENA MOREY MA, RDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 WESTERN AVE
BRATTLEBORO VT
05301-6163
US

IV. Provider business mailing address

972 WESTERN AVE
BRATTLEBORO VT
05301-6163
US

V. Phone/Fax

Practice location:
  • Phone: 802-451-9495
  • Fax:
Mailing address:
  • Phone: 802-451-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: