Basic Information
| Provider Information | |||||||||
| NPI: | 1578945119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORTON | ||||||||
| FirstName: | DEVORAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2094 ALBANY POST RD | ||||||||
| Address2: | BUILDING 13, RM. 15 | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105481454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884825 | ||||||||
| Practice Location | |||||||||
| Address1: | 2094 ALBANY POST RD | ||||||||
| Address2: | BUILDING 13, RM. 15 | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105481454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2015 | ||||||||
| LastUpdateDate: | 06/19/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 082176-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.