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NPI Code Detail

MEDICARE: ETHEL MORAN

MEDICARE: ETHEL 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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2172V00000XCommunity Health Worker
3174H00000XHealth Educator
4171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1376045690
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHEL MORAN
Provider Business Mailing Address
First Line : 2751 BARKER AVE
Second Line :
City : BRONX
State : NY
Zip : 10467-7350
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 820 SAINT ANNS AVE
Second Line :
City : BRONX
State : NY
Zip : 10456-7885
Country : US
Telephone Number : 718-915-6443
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2018
Last Update Date : 08/03/2021

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Directions to “ ETHEL MORAN ” Practice Location

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