Provider Demographics
NPI:1104184019
Name:MORALES, EVA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:JEAN
Last Name:MORALES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 RIDGEWAY PL STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2092
Mailing Address - Country:US
Mailing Address - Phone:505-327-0002
Mailing Address - Fax:505-325-9443
Practice Address - Street 1:1009 RIDGEWAY PL STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2092
Practice Address - Country:US
Practice Address - Phone:505-327-0002
Practice Address - Fax:505-325-9443
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4218104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty