MEDICARE: GEORGETTE MORALES LMSW

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	1041C0700X	Clinical Social Worker	094500	NY

General Provider Information

NPI Number	:	1861887176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGETTE MORALES LMSW

Provider Business Mailing Address
First Line	:	102 PAULA BLVD
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-2636
Country	:	US
Telephone Number	:	631-404-5060
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 PAULA BLVD
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-2636
Country	:	US
Telephone Number	:	631-404-5060
Fax Number	:

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

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	04/02/2015

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