Provider Demographics
NPI:1144640657
Name:MORAZES, LISA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:MORAZES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22075 MALONE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-7024
Mailing Address - Country:US
Mailing Address - Phone:941-204-5282
Mailing Address - Fax:
Practice Address - Street 1:3191 HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6755
Practice Address - Country:US
Practice Address - Phone:941-883-4518
Practice Address - Fax:941-391-5975
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW129871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical