Provider Demographics
NPI:1114497971
Name:MOREA PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:MOREA PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALTHILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:959-200-0189
Mailing Address - Street 1:15 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1957
Mailing Address - Country:US
Mailing Address - Phone:860-785-4124
Mailing Address - Fax:
Practice Address - Street 1:15 N MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1957
Practice Address - Country:US
Practice Address - Phone:860-785-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)