Provider Demographics
NPI:1528190642
Name:MORA, VICTOR HUGO (LCSW)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:HUGO
Last Name:MORA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7872 NW 201ST TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5997
Mailing Address - Country:US
Mailing Address - Phone:305-303-3236
Mailing Address - Fax:
Practice Address - Street 1:1800 W 49TH ST
Practice Address - Street 2:SUITE 324-0
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2900
Practice Address - Country:US
Practice Address - Phone:305-825-3872
Practice Address - Fax:305-825-3873
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66611041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6597AMedicare ID - Type Unspecified