Provider Demographics
NPI:1164490884
Name:MORALES, IVELISSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:IVELISSE
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59-5 CALLE 46
Mailing Address - Street 2:VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5542
Mailing Address - Country:US
Mailing Address - Phone:787-564-6408
Mailing Address - Fax:787-776-5461
Practice Address - Street 1:143-6 CALLE 401
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-4022
Practice Address - Country:US
Practice Address - Phone:787-564-6408
Practice Address - Fax:787-776-5461
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1680103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2303OtherHUMANA HEALTH (APS)
PR187OtherMCS-HMO (APS)
PR187OtherCOSVI-ELA (APS)