=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427620517
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AURA-MARIA MORALES PH.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2021
-----------------------------------------------------
Last Update Date | 07/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 635 W 165TH STREET 6TH FLOOR, OFFICE #621
-----------------------------------------------------
City | NEW YORK CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-9797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 RIDGEFIELD AVE
-----------------------------------------------------
City | BOGOTA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07603-1430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-286-4886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 024407
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------