Provider Demographics
NPI:1386960516
Name:HARRIS, PRUNELLA (LCSW)
Entity type:Individual
Prefix:
First Name:PRUNELLA
Middle Name:
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 1:529 SEVEN BRIDGE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7937
Mailing Address - Country:US
Mailing Address - Phone:570-807-0267
Mailing Address - Fax:
Practice Address - Street 1:529 SEVEN BRIDGE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7937
Practice Address - Country:US
Practice Address - Phone:570-807-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0180181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical