Provider Demographics
NPI:1538043534
Name:MORALES, JANNIE ALICIA (CASAC-T)
Entity type:Individual
Prefix:
First Name:JANNIE
Middle Name:ALICIA
Last Name:MORALES
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16419 104TH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2104
Mailing Address - Country:US
Mailing Address - Phone:718-350-0548
Mailing Address - Fax:
Practice Address - Street 1:1614 WEIRFIELD ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5350
Practice Address - Country:US
Practice Address - Phone:718-456-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC-T-39820101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)