Healthcare Provider Details

I. General information

NPI: 1912368218
Provider Name (Legal Business Name): MARK STEVEN HARREN ATR-BC 08-180
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 34TH ST PENTHOUSE
NEW YORK NY
10001-3006
US

IV. Provider business mailing address

757 UNION ST
BROOKLYN NY
11215-1210
US

V. Phone/Fax

Practice location:
  • Phone: 646-373-6587
  • Fax:
Mailing address:
  • Phone: 646-373-6587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number001725
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: