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General NPI Number Information
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NPI Number | 1013062645
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Entity Type | Individual
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Provider Name | SHIRLEY MARIE HARRIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8600 SHORE FRONT PKWY APT 2P
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City | ROCKAWAY BEACH
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State | NY
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Zip | 11693-2202
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Country | US
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Telephone | 171-894-5456
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Fax |
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Provider Business Mailing Address
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Address Line | 8600 SHOREFRONT PARKWAY APT 2P
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694
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Country | US
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Telephone | 171-894-5456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0699601
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License Number State | NY
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