MEDICARE: MRS. MAUREEN TARAH MOREAU MHC

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
2	101YM0800X	Mental Health Counselor		NY

General Provider Information

NPI Number	:	1275248387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAUREEN TARAH MOREAU MHC

Provider Business Mailing Address
First Line	:	1394 E 53RD ST FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3225
Country	:	US
Telephone Number	:	347-299-9307
Fax Number	:

Provider Business Practice Location Address
First Line	:	1394 E 53RD ST FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3225
Country	:	US
Telephone Number	:	347-299-9307
Fax Number	:

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

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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