Healthcare Provider Details

I. General information

NPI: 1609131069
Provider Name (Legal Business Name): MORRIS FREID VATZ LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3896 OLD COLUMBIA PIKE
ELLICOTT CITY MD
21043-4645
US

IV. Provider business mailing address

3896 OLD COLUMBIA PIKE
ELLICOTT CITY MD
21043-4645
US

V. Phone/Fax

Practice location:
  • Phone: 410-935-6412
  • Fax:
Mailing address:
  • Phone: 410-935-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07116
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: