=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285304048
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEASON HARRIS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2021
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 VILLAGE GRN STE 11
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10506-1245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-901-3880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3
-----------------------------------------------------
City | WACCABUC
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10597-0003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-901-3880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 091173
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------