Provider Demographics
NPI:1235270687
Name:HARRIS, ELLEN L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:L
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 1:41 KENOSIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-792-4141
Mailing Address - Fax:203-794-0536
Practice Address - Street 1:41 KENOSIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-792-4141
Practice Address - Fax:203-794-0536
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004388104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
760795939OtherPHCS
163856OtherVALUE OPTIONS
004254067OtherEDS
2079958OtherCIGNA
267792OtherMHN
267792OtherMHN