=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881182020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANDRA MORSE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2018
-----------------------------------------------------
Last Update Date | 04/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3532 JAMES ST STE 112
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13206-2547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-463-9413
-----------------------------------------------------
Fax | 315-463-9419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 ELDERBERRY LN
-----------------------------------------------------
City | CENTRAL SQUARE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13036-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-288-9563
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 086766
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------