Provider Demographics
NPI:1710225917
Name:MORALES-RIOS, IVELISSE
Entity type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:MORALES-RIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HERITAGE WAY NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4544
Mailing Address - Country:US
Mailing Address - Phone:703-771-5100
Mailing Address - Fax:
Practice Address - Street 1:102 HERITAGE WAY NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4544
Practice Address - Country:US
Practice Address - Phone:703-771-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1710225917103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042622756OtherCOMMONWEALTH
MA1303295OtherMBHP
MA997303OtherNETWORK HEALTH
MA1303295Medicaid
MA8443OtherBMC/BEACON
MA1022610OtherNHP
MA12529OtherHEATLH NEW ENGLAND