Provider Demographics
NPI:1912078114
Name:MORELL, JOSE A (MED,CAGS,LMHC,LADC)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:MORELL
Suffix:
Gender:M
Credentials:MED,CAGS,LMHC,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-3108
Mailing Address - Country:US
Mailing Address - Phone:978-998-0347
Mailing Address - Fax:781-205-1877
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1674
Practice Address - Country:US
Practice Address - Phone:781-277-3300
Practice Address - Fax:781-205-1877
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA021130Medicaid