Healthcare Provider Details

I. General information

NPI: 1811454911
Provider Name (Legal Business Name): DEBRA MORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SOUTH ST
RIDGEFIELD CT
06877
US

IV. Provider business mailing address

21 SOUTH ST
RIDGEFIELD CT
06877-4102
US

V. Phone/Fax

Practice location:
  • Phone: 203-438-6541
  • Fax: 203-798-9200
Mailing address:
  • Phone: 203-438-6541
  • Fax: 203-798-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007896
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: