Provider Demographics
NPI:1295464568
Name:MORRIS, EBONY (LPN, LMSW)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LPN, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 VANDERBILT AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3552
Mailing Address - Country:US
Mailing Address - Phone:718-356-5100
Mailing Address - Fax:
Practice Address - Street 1:320 VANDERBILT AVE APT 5B
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3552
Practice Address - Country:US
Practice Address - Phone:347-636-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119823104100000X
NY332550164W00000X
TX110814104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No164W00000XNursing Service ProvidersLicensed Practical Nurse