Provider Demographics
NPI:1205469392
Name:MORRIS, CORNELL ANDRE (LCSW)
Entity type:Individual
Prefix:MR
First Name:CORNELL
Middle Name:ANDRE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:CORNELL
Other - Middle Name:ANDRE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:ALBANY STRATTON VA MEDICAL CENTER
Mailing Address - Street 2:113 HOLLAND AVENUE
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-626-6928
Mailing Address - Fax:518-626-6953
Practice Address - Street 1:ALBANY STRATTON VA MEDICAL CENTER
Practice Address - Street 2:113 HOLLAND AVENUE
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-626-6928
Practice Address - Fax:518-626-6953
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-44101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical