Provider Demographics
NPI:1740530740
Name:MORAN, MICHAEL JAMES (MA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MORAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1506 PEMBROKE LN
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-7653
Mailing Address - Country:US
Mailing Address - Phone:630-897-1003
Mailing Address - Fax:630-897-1042
Practice Address - Street 1:120 GALE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-5084
Practice Address - Country:US
Practice Address - Phone:630-897-1003
Practice Address - Fax:630-897-1042
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)