Healthcare Provider Details

I. General information

NPI: 1013902063
Provider Name (Legal Business Name): PHILIP CHRISTOPHER MORSE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 03/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 HART BLVD
STATEN ISLAND NY
10301-2613
US

IV. Provider business mailing address

78 HART BLVD 131 SOUTH EUCLID AVENUE, WESTFIELD, NJ 07090
STATEN ISLAND NY
10301-2613
US

V. Phone/Fax

Practice location:
  • Phone: 718-273-3682
  • Fax: 908-232-8148
Mailing address:
  • Phone: 718-273-3682
  • Fax: 908-232-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005414
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSI03538
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: