Provider Demographics
NPI:1073557963
Name:MOROCCO, DANIEL RALPH (EDD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RALPH
Last Name:MOROCCO
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:978-247-6006
Mailing Address - Fax:978-474-6455
Practice Address - Street 1:10 MAIN ST.
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:978-247-6006
Practice Address - Fax:978-474-6455
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0511293Medicaid
MA0511293Medicaid