Provider Demographics
NPI:1699426312
Name:CORVUS, HARPER MAUVE
Entity type:Individual
Prefix:
First Name:HARPER
Middle Name:MAUVE
Last Name:CORVUS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:MARIE
Other - Last Name:FARRAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3962 65TH ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3656
Mailing Address - Country:US
Mailing Address - Phone:917-912-9328
Mailing Address - Fax:
Practice Address - Street 1:3962 65TH ST APT 3C
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3656
Practice Address - Country:US
Practice Address - Phone:201-308-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health