Provider Demographics
NPI:1700883378
Name:MORFORD, MAROLYN E (PHD)
Entity Type:Individual
Prefix:
First Name:MAROLYN
Middle Name:E
Last Name:MORFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 W COLLEGE AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2776
Mailing Address - Country:US
Mailing Address - Phone:814-861-3300
Mailing Address - Fax:814-861-5163
Practice Address - Street 1:1315 W COLLEGE AVE
Practice Address - Street 2:STE 303
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2776
Practice Address - Country:US
Practice Address - Phone:814-861-3300
Practice Address - Fax:814-861-5163
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 8170-L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA17556740005Medicaid