Provider Demographics
NPI:1699488742
Name:MORALES DEYA, OLGA MARIA (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:MARIA
Last Name:MORALES DEYA
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALTS MONTE BRISAS D7
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0103
Mailing Address - Country:US
Mailing Address - Phone:939-268-1617
Mailing Address - Fax:
Practice Address - Street 1:ALTURAS MONTE BRISAS
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3917
Practice Address - Country:US
Practice Address - Phone:939-268-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19521104100000X
PR166281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6265231OtherLISCENSE