1154347037 NPI number — MR. ANTHONY ALLEN MORELLI LCSW

Table of content: MR. ANTHONY ALLEN MORELLI LCSW (NPI 1154347037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154347037 NPI number — MR. ANTHONY ALLEN MORELLI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORELLI
Provider First Name:
ANTHONY
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154347037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/25/2022
NPI Reactivation Date:
02/06/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 143
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMFRET CENTER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06259-0143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
959-444-1434
Provider Business Mailing Address Fax Number:
484-450-4380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 MURDOCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMFRET CENTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06259-9992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
959-444-1434
Provider Business Practice Location Address Fax Number:
484-450-4380
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  004673 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008046918 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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