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General NPI Number Information
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NPI Number | 1639831399
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Entity Type | Individual
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Provider Name | MICHAEL REID HARRIS LMSW
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Gender | Male
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 755 WAVERLY AVE STE 216
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City | HOLTSVILLE
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State | NY
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Zip | 11742-1125
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Country | US
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Telephone | 631-487-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 15 BROOKFIELD LN
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-1444
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Country | US
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Telephone | 631-736-8362
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 113941
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License Number State | NY
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