Healthcare Provider Details

I. General information

NPI: 1144378613
Provider Name (Legal Business Name): AVERA DAWN MORRISON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 SOUTH ST
BARRE MA
01005-8890
US

IV. Provider business mailing address

126 BROOKSIDE RD
ORANGE MA
01364-9516
US

V. Phone/Fax

Practice location:
  • Phone: 978-633-5540
  • Fax:
Mailing address:
  • Phone: 914-815-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number213913
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: