Provider Demographics
NPI:1710101647
Name:MORRISON, ROBERT M (PSYD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:MORRISON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3720
Mailing Address - Country:US
Mailing Address - Phone:908-377-3105
Mailing Address - Fax:
Practice Address - Street 1:2747 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5004
Practice Address - Country:US
Practice Address - Phone:917-586-5652
Practice Address - Fax:718-450-3206
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014325-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical