Healthcare Provider Details

I. General information

NPI: 1699840389
Provider Name (Legal Business Name): SUSAN B MORSE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GOLD AVE SW
ALBUQUERQUE NM
87102-2933
US

IV. Provider business mailing address

2118 CENTRAL AVE SE # 46
ALBUQUERQUE NM
87106-4004
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4785
  • Fax: 505-247-0710
Mailing address:
  • Phone: 505-247-4785
  • Fax: 505-247-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number589
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: