Provider Demographics
NPI:1699840389
Name:MORSE, SUSAN B (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:MORSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2118 CENTRAL AVE SE # 46
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4004
Mailing Address - Country:US
Mailing Address - Phone:505-247-4785
Mailing Address - Fax:505-247-0710
Practice Address - Street 1:1000 GOLD AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2933
Practice Address - Country:US
Practice Address - Phone:505-247-4785
Practice Address - Fax:505-247-0710
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN8217Medicaid
NMR13282Medicare UPIN