Healthcare Provider Details

I. General information

NPI: 1538791744
Provider Name (Legal Business Name): PRISCILLA MORRISON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ALAMEDA DE LAS PULGAS
SAN MATEO CA
94403-1269
US

IV. Provider business mailing address

70 LODATO AVE APT 15
SAN MATEO CA
94403-1748
US

V. Phone/Fax

Practice location:
  • Phone: 650-931-6504
  • Fax:
Mailing address:
  • Phone: 214-769-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY31104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: