Healthcare Provider Details

I. General information

NPI: 1861946592
Provider Name (Legal Business Name): MEGHAN BRENNA MORRIS MSW, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 MOON ST NE
ALBUQUERQUE NM
87112
US

IV. Provider business mailing address

718 COAL AVE SW
ALBUQUERQUE NM
87102-3740
US

V. Phone/Fax

Practice location:
  • Phone: 505-271-0329
  • Fax:
Mailing address:
  • Phone: 103-280-4595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-09945
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberX374537
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-09945
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: