Healthcare Provider Details

I. General information

NPI: 1750426243
Provider Name (Legal Business Name): PHILIP ALLEN MORSE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BRIGHTON AVE UNIT 201
PORTLAND ME
04102-2362
US

IV. Provider business mailing address

335 BRIGHTON AVE UNIT 201
PORTLAND ME
04102-2362
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-8660
  • Fax: 207-662-8492
Mailing address:
  • Phone: 207-662-8660
  • Fax: 207-662-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS848
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3286
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPS848
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number3286
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS848
License Number StateME
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3286
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: