MEDICARE: MS. REBECA M. MORALES LADC II

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1992092613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECA M. MORALES LADC II

Provider Business Mailing Address
First Line	:	131 BEVERLY ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02114-2118
Country	:	US
Telephone Number	:	617-720-0152
Fax Number	:	617-367-9644

Provider Business Practice Location Address
First Line	:	131 BEVERLY ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02114-2118
Country	:	US
Telephone Number	:	617-720-0153
Fax Number	:	617-367-9644

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

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	07/01/2011

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