Provider Demographics
NPI:1811188964
Name:MORRIS, CAROLYN (LCSW-SASD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LCSW-SASD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 W NORTH AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2400
Mailing Address - Country:US
Mailing Address - Phone:414-436-9188
Mailing Address - Fax:
Practice Address - Street 1:10425 W NORTH AVE STE 311
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-2400
Practice Address - Country:US
Practice Address - Phone:414-436-9918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MO20050254111041C0700X
WI73741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43724000Medicaid
WI001484760Medicare PIN
WI000644343Medicare PIN
WI000785068Medicare PIN