MEDICARE: NAIREM ANIKAIRE MORALES-DE JESUS M.A., MFT I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		CA

General Provider Information

NPI Number	:	1023394517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAIREM ANIKAIRE MORALES-DE JESUS M.A., MFT I

Provider Business Mailing Address
First Line	:	1007 AVE. MUNOZ RIVERA
Second Line	:	SUITE 903
City	:	SAN JUAN
State	:	PR
Zip	:	00925-2724
Country	:	US
Telephone Number	:	787-981-4396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 AVE. MUNOZ RIVERA
Second Line	:	903
City	:	SAN JUAN
State	:	PR
Zip	:	00925-2724
Country	:	US
Telephone Number	:	787-981-4396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	06/11/2013

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