Basic Information
| Provider Information | |||||||||
| NPI: | 1417270794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10470 QUEENS BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113753694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182756010 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 760 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112065317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188833580 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 077421 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 251S00000X | 079957 | NY | N | Agencies | Community/Behavioral Health | 1041C0700X | 079957 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.