Provider Demographics
NPI:1225112295
Name:HARRIS- MORAN, ROBERTA (L-CSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:HARRIS- MORAN
Suffix:
Gender:F
Credentials:L-CSW
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:HARRIS- MORAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:L-CSW
Mailing Address - Street 1:1837 HERTEL AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3006
Mailing Address - Country:US
Mailing Address - Phone:716-834-5114
Mailing Address - Fax:716-834-1010
Practice Address - Street 1:1837 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216
Practice Address - Country:US
Practice Address - Phone:716-834-5114
Practice Address - Fax:716-834-5116
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL033962-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY074440564OtherUNITED BEHAVIORAL HEALTH
NY6190173OtherINDEPENDENT HEALTH
NY00511001001OtherBLUE CROSS BLUE SHEILD
NY00025069101OtherUNIVERVA
NYIA0789Medicare ID - Type UnspecifiedMEDICARE
NY00511001001OtherBLUE CROSS BLUE SHEILD
NY174521OtherCOMPSYCH