MEDICARE: MYLINDA MARIE NUDD MORRIS LCSW, CSAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904007290	VA

General Provider Information

NPI Number	:	1366952780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLINDA MARIE NUDD MORRIS LCSW, CSAC

Provider Business Mailing Address
First Line	:	91-2129 KAIOLI ST APT 3304
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-6198
Country	:	US
Telephone Number	:	910-489-7967
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-2135 FORT WEAVER RD STE 501
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-1929
Country	:	US
Telephone Number	:	808-312-6800
Fax Number	:	808-680-0003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	10/11/2017

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