Healthcare Provider Details

I. General information

NPI: 1740500552
Provider Name (Legal Business Name): LILLIAN AMANDA MORRISSEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

53 HILL LN
LEVITTOWN NY
11756-2749
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5657
  • Fax:
Mailing address:
  • Phone: 914-602-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number081222
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: