Provider Demographics
NPI:1740908094
Name:MORGAN, ELAINE J
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:J
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:J
Other - Last Name:STALLOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:635 JAMES ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2661
Mailing Address - Country:US
Mailing Address - Phone:315-671-2964
Mailing Address - Fax:
Practice Address - Street 1:635 JAMES ST STE 1
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2661
Practice Address - Country:US
Practice Address - Phone:315-671-2964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002292106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist