Provider Demographics
NPI:1235757394
Name:MORAIS, ANTONIO (NCC, LAC)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:MORAIS
Suffix:
Gender:M
Credentials:NCC, LAC
Other - Prefix:
Other - First Name:ANTONIO
Other - Middle Name:
Other - Last Name:MORAIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:94 CHURCH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1238
Mailing Address - Country:US
Mailing Address - Phone:732-640-1200
Mailing Address - Fax:732-640-1105
Practice Address - Street 1:94 CHURCH ST STE 301
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1238
Practice Address - Country:US
Practice Address - Phone:732-640-1200
Practice Address - Fax:732-640-1105
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1OtherHORIZON BC/BS