Provider Demographics
NPI:1447984513
Name:MORALES, STEPHANIE CAROLINA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CAROLINA
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 SW 122ND AVE APT 326
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7357
Mailing Address - Country:US
Mailing Address - Phone:178-686-5405
Mailing Address - Fax:
Practice Address - Street 1:2055 SW 122ND AVE APT 326
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7357
Practice Address - Country:US
Practice Address - Phone:178-686-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-178492106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician