Healthcare Provider Details

I. General information

NPI: 1508019050
Provider Name (Legal Business Name): TROY HARRISON LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 TOW PATH RD
ACCORD NY
12404-5515
US

IV. Provider business mailing address

180 TOW PATH RD
ACCORD NY
12404-5515
US

V. Phone/Fax

Practice location:
  • Phone: 845-430-5356
  • Fax:
Mailing address:
  • Phone: 845-430-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR035988-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: