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General NPI Number Information
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NPI Number | 1790198463
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Entity Type | Organization
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Legal Business Name | MICKAELLA MORETA CORP
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 2401 UNIVERSITY PKWY BLDG 1 SUITE 203
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City | SARASOTA
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State | FL
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Zip | 34243-2893
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Country | US
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Telephone | 941-351-2221
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Fax | 941-761-6903
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Provider Business Mailing Address
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Address Line | 2401 UNIVERSITY PKWY BLDG 1 SUITE 203
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City | SARASOTA
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State | FL
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Zip | 34243-2893
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Country | US
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Telephone | 941-351-2221
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Fax | 941-761-6903
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICKAELLA MORETA
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Credential | PHD
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Telephone | 941-351-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PPY185
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License Number State | FL
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