Provider Demographics
NPI:1114002029
Name:MORRIS, ILENE B
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:B
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LEE
Other - Middle Name:B
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCAT, MT-BC
Mailing Address - Street 1:3 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2012
Mailing Address - Country:US
Mailing Address - Phone:631-474-4875
Mailing Address - Fax:
Practice Address - Street 1:3 HEATHER LN
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2012
Practice Address - Country:US
Practice Address - Phone:631-474-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05000102225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist