Provider Demographics
NPI:1497209266
Name:MORAN, ERIN L (MS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:L
Last Name:MORAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12443 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8646
Mailing Address - Country:US
Mailing Address - Phone:904-438-4399
Mailing Address - Fax:
Practice Address - Street 1:12443 SAN JOSE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8646
Practice Address - Country:US
Practice Address - Phone:904-438-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH13965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health