Provider Demographics
NPI:1174053318
Name:HENNESSY, MORGAN LORRAINE (MD, PHD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LORRAINE
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 W 3RD ST STE 650W
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 770
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6108
Practice Address - Country:US
Practice Address - Phone:310-423-8350
Practice Address - Fax:310-423-8351
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA271803208600000X
CAA187629208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery