Provider Demographics
NPI:1063822484
Name:HARRIS, IVA INGRID (MSW)
Entity Type:Individual
Prefix:MRS
First Name:IVA
Middle Name:INGRID
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:IVA
Other - Middle Name:INGRID
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:707 BROADWAY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2360
Mailing Address - Country:US
Mailing Address - Phone:505-565-1761
Mailing Address - Fax:
Practice Address - Street 1:707 BROADWAY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2360
Practice Address - Country:US
Practice Address - Phone:505-565-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator