Provider Demographics
NPI:1518578459
Name:MORAGA, ALYANNA MAE
Entity Type:Individual
Prefix:
First Name:ALYANNA MAE
Middle Name:
Last Name:MORAGA
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 1:22159 E CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1152
Mailing Address - Country:US
Mailing Address - Phone:708-979-2993
Mailing Address - Fax:
Practice Address - Street 1:18220 HARWOOD AVE STE 3
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2151
Practice Address - Country:US
Practice Address - Phone:464-216-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBACB551138106S00000X
1-22-63045103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician