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NPI Code Detail

MEDICARE: DR. RAFAEL MORA DE JESUS PH.D

MEDICARE: DR. RAFAEL MORA DE JESUS PH.D
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
1103T00000XPsychologist001877CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366503906
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAFAEL MORA DE JESUS PH.D
Provider Business Mailing Address
First Line : 210 WETHERSFIELD AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06114-1113
Country : US
Telephone Number : 860-296-0094
Fax Number : 860-206-1184
Provider Business Practice Location Address
First Line : 210 WETHERSFIELD AVE
Second Line :
City : HARTFORD
State : CT
Zip : 06114-1113
Country : US
Telephone Number : 860-296-0094
Fax Number : 860-206-1184
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 07/02/2014

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