Healthcare Provider Details

I. General information

NPI: 1427291392
Provider Name (Legal Business Name): KIMESHA CHANTE MORRIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RETREAT AVE HARTFORD HOSPITAL PSYCHIATRY DEPARTMENT
HARTFORD CT
06106-3310
US

IV. Provider business mailing address

642 HILLIARD ST STE 1310
MANCHESTER CT
06042-2700
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7665
  • Fax:
Mailing address:
  • Phone: 860-936-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006922
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: