Provider Demographics
NPI:1083332613
Name:MORALEZ, ELISE NICOLE
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:NICOLE
Last Name:MORALEZ
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 1:3479 S FEDERAL HWY APT D
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-8683
Mailing Address - Country:US
Mailing Address - Phone:919-924-7352
Mailing Address - Fax:
Practice Address - Street 1:3479 S FEDERAL HWY APT D
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-8683
Practice Address - Country:US
Practice Address - Phone:919-924-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst