Provider Demographics
NPI:1174813190
Name:MOREIRA, ELOISA (MS)
Entity type:Individual
Prefix:
First Name:ELOISA
Middle Name:
Last Name:MOREIRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:HELOISA
Other - Middle Name:
Other - Last Name:MOREIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:168 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-6204
Mailing Address - Country:US
Mailing Address - Phone:631-231-3941
Mailing Address - Fax:631-665-0442
Practice Address - Street 1:1855 UNION BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7949
Practice Address - Country:US
Practice Address - Phone:631-665-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health