Provider Demographics
NPI:1043400559
Name:VINCE MORRISON MSW, PC
Entity Type:Organization
Organization Name:VINCE MORRISON MSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-325-8438
Mailing Address - Street 1:555 BOND ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4230
Mailing Address - Country:US
Mailing Address - Phone:503-325-8438
Mailing Address - Fax:503-325-4402
Practice Address - Street 1:555 BOND ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4230
Practice Address - Country:US
Practice Address - Phone:503-325-8438
Practice Address - Fax:503-325-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL23751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR131913Medicare PIN