Provider Demographics
NPI:1689266025
Name:MORALES, MARISOL (MS, LADC,CAC)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:MS, LADC,CAC
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LADC, CAC
Mailing Address - Street 1:986 QUINNIPIAC AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-2357
Mailing Address - Country:US
Mailing Address - Phone:203-285-7846
Mailing Address - Fax:
Practice Address - Street 1:986 QUINNIPIAC AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-2357
Practice Address - Country:US
Practice Address - Phone:203-285-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001396101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)