Provider Demographics
NPI:1265820450
Name:HARRISON, BEATA (LMSW)
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 CLAUS AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2901
Mailing Address - Country:US
Mailing Address - Phone:631-882-7956
Mailing Address - Fax:
Practice Address - Street 1:21 W 2ND ST STE 19
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2752
Practice Address - Country:US
Practice Address - Phone:631-882-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0919241104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker