Provider Demographics
NPI:1891536058
Name:MORALES MESA, MARIA LUCRESIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUCRESIA
Last Name:MORALES MESA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LUCRESIA
Other - Last Name:MORALES MESA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5600 NE 4TH AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2518
Mailing Address - Country:US
Mailing Address - Phone:786-451-2749
Mailing Address - Fax:
Practice Address - Street 1:5600 NE 4TH AVE APT 106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2518
Practice Address - Country:US
Practice Address - Phone:786-451-2749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24337462106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician