Provider Demographics
NPI:1285996165
Name:HARRIS, ALETHEA LAVITA (MSPLUS30)
Entity type:Individual
Prefix:MS
First Name:ALETHEA
Middle Name:LAVITA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSPLUS30
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13918 109TH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5501
Mailing Address - Country:US
Mailing Address - Phone:718-908-6134
Mailing Address - Fax:718-297-1983
Practice Address - Street 1:97 77 QUEENS BLVD.
Practice Address - Street 2:PENTHOUSE
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3300
Practice Address - Country:US
Practice Address - Phone:718-830-9274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY252Y00000XOtherTEACHER