=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477033264
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NELLIE HARASIMOWICZ LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2018
-----------------------------------------------------
Last Update Date | 04/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 RYE RIDGE PLZ STE 223
-----------------------------------------------------
City | RYE BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10573-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-598-2686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 PARK DR S
-----------------------------------------------------
City | RYE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10580-1826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-617-9940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 092514
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------