Provider Demographics
NPI:1497103337
Name:MORALES MARTINEZ, TERESA MILDRED
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MILDRED
Last Name:MORALES MARTINEZ
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 1:20110 RED RUN DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2119
Mailing Address - Country:US
Mailing Address - Phone:786-369-9000
Mailing Address - Fax:
Practice Address - Street 1:20110 RED RUN DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2119
Practice Address - Country:US
Practice Address - Phone:786-369-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL1-19-38640103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health