Provider Demographics
NPI:1609055672
Name:MOREY, THEODORE MARK (PHD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:MARK
Last Name:MOREY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 COUNTY ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5669
Mailing Address - Country:US
Mailing Address - Phone:315-342-3026
Mailing Address - Fax:
Practice Address - Street 1:1085 COUNTY ROUTE 20
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-5669
Practice Address - Country:US
Practice Address - Phone:315-342-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7817103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical