Provider Demographics
NPI:1417023045
Name:LASSON, MORRIS SAMUEL (PHD)
Entity Type:Individual
Prefix:MR
First Name:MORRIS
Middle Name:SAMUEL
Last Name:LASSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 BEDFORD AVENUE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3701
Mailing Address - Country:US
Mailing Address - Phone:410-486-0999
Mailing Address - Fax:410-602-1776
Practice Address - Street 1:1314 BEDFORD AVENUE
Practice Address - Street 2:SUITE 211
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3701
Practice Address - Country:US
Practice Address - Phone:410-486-0999
Practice Address - Fax:410-602-1776
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00492103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R09350Medicare UPIN
MDG485Medicare ID - Type Unspecified