Provider Demographics
NPI:1306395140
Name:GARCIA MORALES, BRENDALY
Entity Type:Individual
Prefix:
First Name:BRENDALY
Middle Name:
Last Name:GARCIA MORALES
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 1:3326 PASEO CARMEN
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3136
Mailing Address - Country:US
Mailing Address - Phone:787-784-7200
Mailing Address - Fax:787-761-0613
Practice Address - Street 1:3326 AVE BOULEVARD
Practice Address - Street 2:TERCERA SECCION URB LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-7200
Practice Address - Fax:787-761-0613
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5672103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5672OtherLICENSE