Provider Demographics
NPI:1831395136
Name:MORSE, STANLEY J (PHD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:J
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:PO BOX 541056
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02454-1056
Mailing Address - Country:US
Mailing Address - Phone:781-354-4897
Mailing Address - Fax:781-207-8456
Practice Address - Street 1:37 HARLAND RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-7613
Practice Address - Country:US
Practice Address - Phone:781-354-4897
Practice Address - Fax:781-207-8456
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4140103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW4024OtherBLUE CROSS BLUE SHIELD
MAW4024OtherBLUE CROSS BLUE SHIELD