Provider Demographics
NPI:1487068045
Name:MORALES, ANA LETICIA (PHD)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LETICIA
Last Name:MORALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 CALLE SALUEN
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3042
Mailing Address - Country:US
Mailing Address - Phone:787-602-6031
Mailing Address - Fax:
Practice Address - Street 1:759 AVELINO VICENTE, SANTURCE
Practice Address - Street 2:PARADA 22
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-303-9662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5500103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1487068045OtherZONA DE DESARROLLO