Provider Demographics
NPI:1528215936
Name:MORA, ANGELA ROSA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ROSA
Last Name:MORA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2078 WALLACE AVE APT 332
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2559
Mailing Address - Country:US
Mailing Address - Phone:646-591-7528
Mailing Address - Fax:
Practice Address - Street 1:2078 WALLACE AVE APT 332
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2559
Practice Address - Country:US
Practice Address - Phone:646-591-7528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075257-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical