Provider Demographics
NPI:1326612508
Name:DETOR, MORGAN M
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:M
Last Name:DETOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7048 LAURELWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9014
Mailing Address - Country:US
Mailing Address - Phone:912-656-9100
Mailing Address - Fax:
Practice Address - Street 1:3532 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2488
Practice Address - Country:US
Practice Address - Phone:912-656-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094029104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker