Provider Demographics
NPI:1336484112
Name:MORA, LOUIS ERNESTO (PHD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ERNESTO
Last Name:MORA
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MELROSE PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-6269
Mailing Address - Country:US
Mailing Address - Phone:347-740-5690
Mailing Address - Fax:833-255-9073
Practice Address - Street 1:30 STATION COURT
Practice Address - Street 2:SUITE 21
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2454
Practice Address - Country:US
Practice Address - Phone:347-740-5690
Practice Address - Fax:833-225-9073
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018957-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist