Healthcare Provider Details

I. General information

NPI: 1881668184
Provider Name (Legal Business Name): MARGOT HARRIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 SEGUINE AVENUE
STATEN ISLAND NY
10309
US

IV. Provider business mailing address

43 OAK HILLS RD
EDISON NJ
08820-3603
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-2874
  • Fax: 718-226-2658
Mailing address:
  • Phone: 732-548-7178
  • Fax: 732-548-1667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberR0282051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: