Healthcare Provider Details

I. General information

NPI: 1487164364
Provider Name (Legal Business Name): MORGAN LYNN HERRON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN LYNN MULLER LMSW

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 DANBY RD STE 202F
ITHACA NY
14850-5714
US

IV. Provider business mailing address

950 DANBY RD STE 202F
ITHACA NY
14850-5714
US

V. Phone/Fax

Practice location:
  • Phone: 607-260-3100
  • Fax:
Mailing address:
  • Phone: 607-260-3100
  • Fax: 607-334-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101394-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090899-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: