Provider Demographics
NPI:1770926347
Name:MCMORRIS, EDWARD M I
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:M
Last Name:MCMORRIS
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:M
Other - Last Name:MCMORRIS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:CASAC-T
Mailing Address - Street 1:6207 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3576
Mailing Address - Country:US
Mailing Address - Phone:718-898-5085
Mailing Address - Fax:718-898-5582
Practice Address - Street 1:6207 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3576
Practice Address - Country:US
Practice Address - Phone:718-898-5085
Practice Address - Fax:718-898-5085
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28720171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator