Provider Demographics
NPI:1679146898
Name:MORALES, PHOENIX DELORES (LCSW)
Entity Type:Individual
Prefix:
First Name:PHOENIX
Middle Name:DELORES
Last Name:MORALES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 TRAFALGAR ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2033
Mailing Address - Country:US
Mailing Address - Phone:616-401-9047
Mailing Address - Fax:
Practice Address - Street 1:3149 TRAFALGAR ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2033
Practice Address - Country:US
Practice Address - Phone:616-401-9047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA142861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical