Provider Demographics
NPI:1063910990
Name:HARRIS, SHANICE (LMSW)
Entity type:Individual
Prefix:
First Name:SHANICE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 E EAGER ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2508
Mailing Address - Country:US
Mailing Address - Phone:347-902-5628
Mailing Address - Fax:
Practice Address - Street 1:21 E EAGER ST APT 2F
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2508
Practice Address - Country:US
Practice Address - Phone:347-902-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty