Provider Demographics
NPI:1083105498
Name:MORSE, STEPHEN J
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:MORSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CHERRY ST APT 14B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1064
Mailing Address - Country:US
Mailing Address - Phone:917-566-6099
Mailing Address - Fax:
Practice Address - Street 1:2301 CHERRY ST APT 14B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1064
Practice Address - Country:US
Practice Address - Phone:917-566-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1670-PY-PR103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic