Provider Demographics
NPI:1770212128
Name:MORA, CARMEN (LSW)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MORA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:LEYVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:3 GIBRALTAR CT
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2518
Mailing Address - Country:US
Mailing Address - Phone:732-618-3199
Mailing Address - Fax:
Practice Address - Street 1:1466 HOOPER AVE STE 1
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2892
Practice Address - Country:US
Practice Address - Phone:848-848-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL067973001041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical