Healthcare Provider Details

I. General information

NPI: 1184149098
Provider Name (Legal Business Name): PAIGE CECILIA ALSTON HARRIS MSW, ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 E SHAW AVE STE 139
FRESNO CA
93710-8025
US

IV. Provider business mailing address

PO BOX 710041
SAN DIEGO CA
92171-0041
US

V. Phone/Fax

Practice location:
  • Phone: 559-320-0490
  • Fax:
Mailing address:
  • Phone: 559-649-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: