Healthcare Provider Details

I. General information

NPI: 1295985885
Provider Name (Legal Business Name): JEFF MORRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOSTON AVE STE 1925
MEDFORD MA
02155-4243
US

IV. Provider business mailing address

200 BOSTON AVE STE 1925
MEDFORD MA
02155-4243
US

V. Phone/Fax

Practice location:
  • Phone: 617-315-8256
  • Fax: 978-356-2822
Mailing address:
  • Phone: 617-315-8256
  • Fax: 978-356-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10001588
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: