Mora De Jesus, Rafael

Mora De Jesus, Rafael is an sole proprietor health care provider with primary practice located at 210 Wethersfield Ave , Hartford CT 06114-1113. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Mora De Jesus, Rafael can be contacted via phone (860) 296-0094.

Contact Information

Primary practice address
210 Wethersfield Ave Hartford CT 06114-1113
Phone: (860) 296-0094
Fax: (860) 206-1184
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 001877 Connecticut

Profile Details

NPI number 1366503906
LBN Legal business name Mora De Jesus, Rafael
Credentials PH.D
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 13th, 2006
Last updated Jul 2nd, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366503906 NPPES
Connecticut MEDICAID 004132700

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