Basic Information
Provider Information
NPI: 1588286090
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAYLOR
FirstName: MORGAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 800386
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229080386
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1215 LEE ST
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229080816
CountryCode: US
TelephoneNumber: 4349240000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/07/2020
LastUpdateDate: 05/07/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X0904009070VAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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