Provider Demographics
NPI:1235112145
Name:MORRISON, ELIZABETH C (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:MORRISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 OAKDALE RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3361
Mailing Address - Country:US
Mailing Address - Phone:209-869-5678
Mailing Address - Fax:209-869-6357
Practice Address - Street 1:2603 PATTERSON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-3407
Practice Address - Country:US
Practice Address - Phone:209-869-5678
Practice Address - Fax:209-869-6357
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS225851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ45718Medicare UPIN
CAZZZ01919ZMedicare PIN