Provider Demographics
NPI:1124808886
Name:HARRIS, CAS'SHEAIRA NATONIA
Entity type:Individual
Prefix:
First Name:CAS'SHEAIRA
Middle Name:NATONIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25132 BOOKER AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-5843
Mailing Address - Country:US
Mailing Address - Phone:216-835-1175
Mailing Address - Fax:
Practice Address - Street 1:25132 BOOKER AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-5843
Practice Address - Country:US
Practice Address - Phone:216-835-1175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0700X, 251C00000X, 261QD1600X, 103TM1800X
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty