1881079291 NPI number — MS. KIMBERLY MARIE MORALES MSW

Table of content: MS. KIMBERLY MARIE MORALES MSW (NPI 1881079291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881079291 NPI number — MS. KIMBERLY MARIE MORALES MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES
Provider First Name:
KIMBERLY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881079291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E MONUMENT AVE
Provider Second Line Business Mailing Address:
SUITE 401 OFFICE 2
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34741-5762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-930-4711
Provider Business Mailing Address Fax Number:
866-255-1576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 E MONUMENT AVE
Provider Second Line Business Practice Location Address:
SUITE 401 OFFICE 2
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-5762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-930-4711
Provider Business Practice Location Address Fax Number:
866-255-1576
Provider Enumeration Date:
07/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  PSW964 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FL922013Z , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 922013Z . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: EAHCA020Z . This is a "AHCA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: EAHCA790Z . This is a "MANAGED CARE HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 017280000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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