Provider Demographics
NPI:1669278644
Name:MORALES, SERGIO BRUNO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:BRUNO
Last Name:MORALES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 N HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40146-6931
Mailing Address - Country:US
Mailing Address - Phone:270-945-7255
Mailing Address - Fax:
Practice Address - Street 1:1235 31ST ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2688
Practice Address - Country:US
Practice Address - Phone:812-547-9727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-23-311134106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician