Healthcare Provider Details

I. General information

NPI: 1982910071
Provider Name (Legal Business Name): LENA MARIE MCMORRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 GRANT ST
NEW HAVEN CT
06519-2514
US

IV. Provider business mailing address

62 GRANT ST
NEW HAVEN CT
06519-2514
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3350
  • Fax: 203-503-3370
Mailing address:
  • Phone: 203-503-3350
  • Fax: 203-503-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: