Provider Demographics
NPI:1154166072
Name:MORALES FERNANDEZ, GLORIMAR ENID
Entity type:Individual
Prefix:
First Name:GLORIMAR
Middle Name:ENID
Last Name:MORALES FERNANDEZ
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:PO BOX 1501
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1501
Mailing Address - Country:US
Mailing Address - Phone:787-672-1522
Mailing Address - Fax:787-895-8900
Practice Address - Street 1:CARR #2 KM 99.0
Practice Address - Street 2:BO COCOS
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-672-1522
Practice Address - Fax:787-895-8900
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7985103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent