Provider Demographics
NPI:1750679320
Name:MORALES, MAYDELINE (MS)
Entity Type:Individual
Prefix:MS
First Name:MAYDELINE
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6553
Mailing Address - Country:US
Mailing Address - Phone:646-245-0052
Mailing Address - Fax:845-592-2724
Practice Address - Street 1:610 S HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6553
Practice Address - Country:US
Practice Address - Phone:646-245-0052
Practice Address - Fax:845-592-2724
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
NY719946103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool