MEDICARE: MRS. CARMEN MORAN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1306598198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN MORAN

Provider Business Mailing Address
First Line	:	PO BOX 129
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-0129
Country	:	US
Telephone Number	:	623-250-5239
Fax Number	:	623-439-7349

Provider Business Practice Location Address
First Line	:	11225 N 28TH DR STE C206
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5600
Country	:	US
Telephone Number	:	623-250-5239
Fax Number	:	623-439-7349

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

Provider Enumeration Date	:	01/22/2022
Last Update Date	:	05/13/2025

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Directions to “ MRS. CARMEN MORAN ” Practice Location

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