Provider Demographics
NPI:1770687212
Name:AXELROD, MORTON L (PHD)
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:L
Last Name:AXELROD
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 1:366 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3132
Mailing Address - Country:US
Mailing Address - Phone:800-290-0989
Mailing Address - Fax:610-265-1797
Practice Address - Street 1:366 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3132
Practice Address - Country:US
Practice Address - Phone:800-290-0989
Practice Address - Fax:610-265-1797
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001541101YM0800X, 106H00000X, 101YP2500X
PA102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000374984OtherUNITED BEHAVIORAL HEALTH - UBH
PA11654143OtherCAQH
PA7196480OtherAETNA
PA7196480OtherAETNA
PA117994000OtherKEYSTONE