Basic Information
| Provider Information | |||||||||
| NPI: | 1881838498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORALES | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | MANUEL | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 588 GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | DEER PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117295320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314554315 | ||||||||
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| Practice Location | |||||||||
| Address1: | 796H DREW ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112084704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182353100 | ||||||||
| FaxNumber: | 7182770822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2009 | ||||||||
| LastUpdateDate: | 06/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 00072916 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.