Provider Demographics
NPI:1487719704
Name:MORRIS, KATHLEEN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2514
Mailing Address - Country:US
Mailing Address - Phone:518-669-3639
Mailing Address - Fax:
Practice Address - Street 1:1262 LOWELL RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2514
Practice Address - Country:US
Practice Address - Phone:518-669-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010414103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16412OtherUBH
NY172739OtherMHN
NY41315OtherMVP
NYPVPB206541OtherAPS
NY134853OtherCDPHP
NY000407039002OtherBSNENY
NY7333991OtherVALUE OPTIONS
NYDD6344Medicare ID - Type Unspecified