Provider Demographics
NPI:1790356137
Name:MORALES DENIS, LOURDES (TCM SUPERVISOR)
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:
Last Name:MORALES DENIS
Suffix:
Gender:F
Credentials:TCM SUPERVISOR
Other - Prefix:MS
Other - First Name:LOURDES
Other - Middle Name:MORALES
Other - Last Name:MORALES DENIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:9364 SW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4124
Mailing Address - Country:US
Mailing Address - Phone:305-345-4898
Mailing Address - Fax:
Practice Address - Street 1:9364 SW 37TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4124
Practice Address - Country:US
Practice Address - Phone:305-345-4898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-54653103K00000X
FLCBHCM100344104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker