Provider Demographics
NPI:1700011418
Name:MORELLI, MARY ELLEN (MSW/LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:MORELLI
Suffix:
Gender:F
Credentials:MSW/LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 GULF RD
Mailing Address - Street 2:# 17
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-1590
Mailing Address - Country:US
Mailing Address - Phone:774-202-2952
Mailing Address - Fax:
Practice Address - Street 1:153 GULF RD
Practice Address - Street 2:# 17
Practice Address - City:SOUTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-1590
Practice Address - Country:US
Practice Address - Phone:774-202-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW10158371041C0700X
RIISW003391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2647Medicaid
RI2647Medicaid
MA6721073375Medicare UPIN
MA6721073375Medicare PIN
MA6721073375Medicare NSC
RI6721073375Medicare NSC
RI6721073375Medicare UPIN
RI6721073375Medicare PIN