Healthcare Provider Details

I. General information

NPI: 1467946319
Provider Name (Legal Business Name): MICHELE MORSE AUSTIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 GARRISON RD
HINGHAM MA
02043-2855
US

IV. Provider business mailing address

41 GARRISON RD
HINGHAM MA
02043-2855
US

V. Phone/Fax

Practice location:
  • Phone: 781-223-0782
  • Fax:
Mailing address:
  • Phone: 781-223-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7290-PY-PR
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number7290-PY-PR
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7290-PY-PR
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: