Provider Demographics
NPI:1497933782
Name:MORGRET, EDWARD VICTOR (PHD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:VICTOR
Last Name:MORGRET
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 1:111 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1522
Mailing Address - Country:US
Mailing Address - Phone:304-822-3528
Mailing Address - Fax:
Practice Address - Street 1:111 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1522
Practice Address - Country:US
Practice Address - Phone:304-822-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22006103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0163471000Medicaid