Provider Demographics
NPI:1548245756
Name:MORALES, ROBERTO (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:8350 CRAIG ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-3593
Mailing Address - Country:US
Mailing Address - Phone:317-436-7409
Mailing Address - Fax:
Practice Address - Street 1:7739 E 88TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1231
Practice Address - Country:US
Practice Address - Phone:317-288-4767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
IN20042982A103TH0100X
PAPS016017103T00000X
GA2715103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74144Medicare ID - Type UnspecifiedFLORIDA MEDICARE