Healthcare Provider Details

I. General information

NPI: 1083454946
Provider Name (Legal Business Name): TANAJAH SIMONE HARRIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N MAIN ST
MANCHESTER CT
06042-2086
US

IV. Provider business mailing address

15 FOREST ST UNIT K
MANCHESTER CT
06040-5955
US

V. Phone/Fax

Practice location:
  • Phone: 860-533-3434
  • Fax:
Mailing address:
  • Phone: 860-281-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9733
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: