Basic Information
| Provider Information | |||||||||
| NPI: | 1487809356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORY | ||||||||
| FirstName: | CONSUELO | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3305 92ND ST | ||||||||
| Address2: | APT 6G | ||||||||
| City: | JACKSON HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113721847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185058201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8956 162ND ST | ||||||||
| Address2: | 2 FLOOR | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114325072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186577100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2008 | ||||||||
| LastUpdateDate: | 11/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.