Provider Demographics
NPI:1114439668
Name:MORA, ELISE MARIE (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MARIE
Last Name:MORA
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 LOREWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-1525
Mailing Address - Country:US
Mailing Address - Phone:302-304-4967
Mailing Address - Fax:
Practice Address - Street 1:100 W 10TH ST STE 315
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1642
Practice Address - Country:US
Practice Address - Phone:302-652-6776
Practice Address - Fax:302-652-5150
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00015801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical