Healthcare Provider Details

I. General information

NPI: 1689989063
Provider Name (Legal Business Name): MAGGIE MORRISETTE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 W BELLEVUE DR
PASADENA CA
91105-2501
US

IV. Provider business mailing address

2047 LAS LUNAS ST
PASADENA CA
91107-2349
US

V. Phone/Fax

Practice location:
  • Phone: 626-274-1556
  • Fax:
Mailing address:
  • Phone: 626-274-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: