Provider Demographics
NPI:1750057097
Name:MORELL, ERICK
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:MORELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15620 NW 157TH STREET RD
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6925
Mailing Address - Country:US
Mailing Address - Phone:786-398-1549
Mailing Address - Fax:
Practice Address - Street 1:15620 NW 157TH STREET RD
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-6925
Practice Address - Country:US
Practice Address - Phone:786-398-1549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty