Provider Demographics
NPI:1457173387
Name:MORERA, EILYN
Entity type:Individual
Prefix:
First Name:EILYN
Middle Name:
Last Name:MORERA
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 1:8615 NW 5TH TER APT 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3879
Mailing Address - Country:US
Mailing Address - Phone:786-438-7310
Mailing Address - Fax:
Practice Address - Street 1:8615 NW 5TH TER APT 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3879
Practice Address - Country:US
Practice Address - Phone:786-438-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-387356106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician