Provider Demographics
NPI:1043974355
Name:MORAN, HANNAH
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 ARIZONA ST
Mailing Address - Street 2:
Mailing Address - City:ALFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32420-6802
Mailing Address - Country:US
Mailing Address - Phone:850-340-0543
Mailing Address - Fax:
Practice Address - Street 1:211 W IOWA AVE
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-2103
Practice Address - Country:US
Practice Address - Phone:850-419-5061
Practice Address - Fax:888-545-1603
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-299461106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician