Provider Demographics
NPI:1881079291
Name:MORALES, KIMBERLY MARIE (MSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:MORALES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E MONUMENT AVE
Mailing Address - Street 2:SUITE 401 OFFICE 2
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5762
Mailing Address - Country:US
Mailing Address - Phone:407-930-4711
Mailing Address - Fax:866-255-1576
Practice Address - Street 1:111 E MONUMENT AVE
Practice Address - Street 2:SUITE 401 OFFICE 2
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5762
Practice Address - Country:US
Practice Address - Phone:407-930-4711
Practice Address - Fax:866-255-1576
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSW964104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL922013ZMedicaid
FL922013ZOtherWELLCARE
FLEAHCA020ZOtherAHCA
FLEAHCA790ZOtherMANAGED CARE HEALTH