Provider Demographics
NPI:1558782607
Name:MORRIS, RODERICK (CASACT)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:MORRIS
Suffix:
Gender:M
Credentials:CASACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5101
Mailing Address - Country:US
Mailing Address - Phone:718-584-7204
Mailing Address - Fax:718-584-8394
Practice Address - Street 1:2488 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5101
Practice Address - Country:US
Practice Address - Phone:718-584-7204
Practice Address - Fax:718-584-8394
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)