Provider Demographics
NPI:1538320981
Name:MOREIRA, RAFAEL SEGUNDO (LMHC)
Entity type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:SEGUNDO
Last Name:MOREIRA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 30TH AVE APT 321
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1552
Mailing Address - Country:US
Mailing Address - Phone:718-205-1047
Mailing Address - Fax:
Practice Address - Street 1:7410 35TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-8197
Practice Address - Country:US
Practice Address - Phone:718-672-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000289-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health