Provider Demographics
NPI:1750864427
Name:MORAES, DEIRDRE D (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:D
Last Name:MORAES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 AVERY ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2035
Mailing Address - Country:US
Mailing Address - Phone:617-803-2793
Mailing Address - Fax:
Practice Address - Street 1:1221 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5311
Practice Address - Country:US
Practice Address - Phone:413-333-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10202161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical