Provider Demographics
NPI:1083415194
Name:HARRIS, LISA M (MHC-LP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WINTHROP PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3043
Mailing Address - Country:US
Mailing Address - Phone:718-816-6760
Mailing Address - Fax:718-667-3260
Practice Address - Street 1:38 WINTHROP PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3043
Practice Address - Country:US
Practice Address - Phone:718-816-6760
Practice Address - Fax:718-667-3260
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP132050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health