Provider Demographics
NPI:1699450320
Name:ARROYO MORA, KEREN MIGLENA (LCAT-P)
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:MIGLENA
Last Name:ARROYO MORA
Suffix:
Gender:F
Credentials:LCAT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3193
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-3193
Practice Address - Country:US
Practice Address - Phone:332-223-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP120906103K00000X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst