Provider Demographics
NPI:1982180238
Name:MORALES, MARINE (ATR)
Entity Type:Individual
Prefix:
First Name:MARINE
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 E 23RD ST # 1252
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3765
Mailing Address - Country:US
Mailing Address - Phone:201-682-4788
Mailing Address - Fax:
Practice Address - Street 1:149 E 23RD ST # 1252
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3765
Practice Address - Country:US
Practice Address - Phone:702-801-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYK028863221700000X
M263478ID221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty