Provider Demographics
NPI:1609605104
Name:MORELL HERNANDEZ, CARLOS RAFAEL
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAFAEL
Last Name:MORELL HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-2544
Mailing Address - Country:US
Mailing Address - Phone:561-876-0028
Mailing Address - Fax:
Practice Address - Street 1:2924 4TH ST SW
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-2544
Practice Address - Country:US
Practice Address - Phone:561-876-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician