Provider Demographics
NPI:1861994816
Name:MOREJON, MAELYS C
Entity type:Individual
Prefix:MS
First Name:MAELYS
Middle Name:C
Last Name:MOREJON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAELYS
Other - Middle Name:NA
Other - Last Name:MOREJON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BEHAVIOR ANALYST
Mailing Address - Street 1:155 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5418
Mailing Address - Country:US
Mailing Address - Phone:786-975-6234
Mailing Address - Fax:
Practice Address - Street 1:7875 NW 12TH ST STE 109
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1815
Practice Address - Country:US
Practice Address - Phone:786-269-3502
Practice Address - Fax:305-468-6154
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-21-12899106E00000X
FL1-23-65947103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103054800Medicaid