Provider Demographics
NPI:1407947914
Name:MORALES, LISSET (LMHC, BCBA, NCC)
Entity Type:Individual
Prefix:
First Name:LISSET
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:LMHC, BCBA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 SW 153RD PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2756
Mailing Address - Country:US
Mailing Address - Phone:786-223-4575
Mailing Address - Fax:
Practice Address - Street 1:869 SW 153RD PATH
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194
Practice Address - Country:US
Practice Address - Phone:786-223-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9700101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017782100Medicaid
FL003529800Medicaid