MEDICARE: NICHOLAS MORALES

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	390200000X	Student in an Organized Health Care Education/Training Program
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1205484193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MORALES

Provider Business Mailing Address
First Line	:	PO BOX 685
Second Line	:
City	:	HARRISON
State	:	NY
Zip	:	10528-0685
Country	:	US
Telephone Number	:	646-513-2866
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 UNIVERSITY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-6102
Country	:	US
Telephone Number	:	646-513-2866
Fax Number	:

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

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	09/03/2019

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Directions to “ NICHOLAS MORALES ” Practice Location

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