Provider Demographics
NPI:1750426243
Name:MORSE, PHILIP ALLEN (PHD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ALLEN
Last Name:MORSE
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 1:335 BRIGHTON AVE
Mailing Address - Street 2:UNIT 201
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2362
Mailing Address - Country:US
Mailing Address - Phone:207-662-8660
Mailing Address - Fax:207-662-8492
Practice Address - Street 1:335 BRIGHTON AVE
Practice Address - Street 2:UNIT 201
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2362
Practice Address - Country:US
Practice Address - Phone:207-662-8660
Practice Address - Fax:207-662-8492
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS848103G00000X, 103TA0700X, 103TC0700X
MA3286103G00000X, 103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
043391454OtherFED TAX ID
ME154880099Medicaid
OTH000Medicare UPIN
MEMM5934Medicare ID - Type Unspecified