Healthcare Provider Details

I. General information

NPI: 1477177350
Provider Name (Legal Business Name): NICHOLAS M MORELLI PHD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W PUTNAM AVE
GREENWICH CT
06830-6086
US

IV. Provider business mailing address

500 W PUTNAM AVE
GREENWICH CT
06830-6086
US

V. Phone/Fax

Practice location:
  • Phone: 212-289-8001
  • Fax: 203-276-2027
Mailing address:
  • Phone: 212-289-8001
  • Fax: 203-276-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: