Provider Demographics
NPI:1730726324
Name:MORRIS, SAMANTHA R (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 MANSFIELD ROAD
Mailing Address - Street 2:UNIT 1255
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-1255
Mailing Address - Country:US
Mailing Address - Phone:860-486-4705
Mailing Address - Fax:860-486-9159
Practice Address - Street 1:377 MANSFIELD ROAD
Practice Address - Street 2:UNIT 1255
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-1255
Practice Address - Country:US
Practice Address - Phone:860-486-4705
Practice Address - Fax:860-486-9159
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003497103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical