MEDICARE: LUIS MORALES LICSW

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	LC50077919	DC

General Provider Information

NPI Number	:	1558589036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS MORALES LICSW

Provider Business Mailing Address
First Line	:	1460 COLUMBIA RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-4764
Country	:	US
Telephone Number	:	202-538-4079
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 N ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3347
Country	:	US
Telephone Number	:	202-442-6090
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	03/09/2009

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Directions to “ LUIS MORALES LICSW” Practice Location

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