Healthcare Provider Details

I. General information

NPI: 1295464568
Provider Name (Legal Business Name): EBONY MORRIS LPN, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 VANDERBILT AVE APT 5B
STATEN ISLAND NY
10304-3552
US

IV. Provider business mailing address

320 VANDERBILT AVE APT 5B
STATEN ISLAND NY
10304-3552
US

V. Phone/Fax

Practice location:
  • Phone: 347-636-8482
  • Fax:
Mailing address:
  • Phone: 718-356-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119823
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number332550
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110814
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: