Basic Information
Provider Information
NPI: 1023747904
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOREL HILARIO
FirstName: ANA
MiddleName: IRIS
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 933 E COLUMBUS AVE
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011052509
CountryCode: US
TelephoneNumber: 4132966185
FaxNumber: 4134552990
Practice Location
Address1: 2155 MAIN ST
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011043301
CountryCode: US
TelephoneNumber: 4137368329
FaxNumber: 4134552990
Other Information
ProviderEnumerationDate: 06/07/2022
LastUpdateDate: 06/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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