=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881668184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGOT HARRIS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 392 SEGUINE AVENUE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-226-2874
-----------------------------------------------------
Fax | 718-226-2658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 OAK HILLS RD
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08820-3603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-548-7178
-----------------------------------------------------
Fax | 732-548-1667
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | R0282051
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------