Provider Demographics
NPI:1144997875
Name:MORALES, VANESSA MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MARIE
Last Name:MORALES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4036
Mailing Address - Country:US
Mailing Address - Phone:860-643-3200
Mailing Address - Fax:860-643-3201
Practice Address - Street 1:18 WESTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1504
Practice Address - Country:US
Practice Address - Phone:860-527-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)