Provider Demographics
NPI:1497433197
Name:MORALES MILLAN, KELVIN L (PHD)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:L
Last Name:MORALES MILLAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D12 CALLE MIS AMORES SAN ALFONSO
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5827
Mailing Address - Country:US
Mailing Address - Phone:787-930-3144
Mailing Address - Fax:
Practice Address - Street 1:D12 CALLE MIS AMORES SAN ALFONSO
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5827
Practice Address - Country:US
Practice Address - Phone:787-930-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR8209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program