Provider Demographics
NPI:1043682602
Name:MORRIS, CORNELIA (LADC)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:CORNELIA
Other - Middle Name:
Other - Last Name:EDGEWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:12 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4103
Mailing Address - Country:US
Mailing Address - Phone:203-589-4912
Mailing Address - Fax:
Practice Address - Street 1:12 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4103
Practice Address - Country:US
Practice Address - Phone:203-589-4912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001158101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)