Provider Demographics
NPI:1114001393
Name:MORALES OLIVER, LESLIE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MORALES OLIVER
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 1:23 NORTH RD
Mailing Address - Street 2:UNIT A-21
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-2176
Mailing Address - Country:US
Mailing Address - Phone:401-789-0810
Mailing Address - Fax:401-364-0099
Practice Address - Street 1:23 NORTH RD
Practice Address - Street 2:UNIT A-21
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-2176
Practice Address - Country:US
Practice Address - Phone:401-789-0810
Practice Address - Fax:401-364-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW007081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI254058OtherMAGELLAN HEALTH SERVICES
RI30667-2OtherRI BLUE CROSS BLUE SHIELD
RI406127OtherBLUE CHIP
RI050572443OtherUNITED HEALTHCARE; AETNA
RI1027350OtherNHPRI
RI30667-2OtherRI BLUE CROSS BLUE SHIELD
RI254058OtherMAGELLAN HEALTH SERVICES