Provider Demographics
NPI:1770314494
Name:MOREIRA, CLAUDIA LOPES
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:LOPES
Last Name:MOREIRA
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 1:832 MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6176
Mailing Address - Country:US
Mailing Address - Phone:508-789-0542
Mailing Address - Fax:
Practice Address - Street 1:832 MAIN ST APT 2
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6176
Practice Address - Country:US
Practice Address - Phone:508-789-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SA5600170106S00000X, 103TS0200X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty