Provider Demographics
NPI:1194881862
Name:HARRIS, MONICA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-0716
Mailing Address - Country:US
Mailing Address - Phone:631-287-2813
Mailing Address - Fax:631-287-2813
Practice Address - Street 1:134 SAINT ANDREWS CIRCLE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-3818
Practice Address - Country:US
Practice Address - Phone:631-287-2813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0282061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7494055OtherGROUP HEALTH INS
P1071976OtherOXFORD HEALTH PLANS
N39321Medicare ID - Type Unspecified