Provider Demographics
NPI:1205600657
Name:TIRADO MORALES, MAIRELYS
Entity type:Individual
Prefix:
First Name:MAIRELYS
Middle Name:
Last Name:TIRADO MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25060 SW 122ND PL # 8127
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8127
Mailing Address - Country:US
Mailing Address - Phone:786-878-2432
Mailing Address - Fax:
Practice Address - Street 1:25060 SW 122ND PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8127
Practice Address - Country:US
Practice Address - Phone:786-878-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-307129106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician