Provider Demographics
NPI:1295185437
Name:HARRISON, KIYAH (LCSW, LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:KIYAH
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LCSW, LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 NIMROD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1501
Mailing Address - Country:US
Mailing Address - Phone:631-805-0543
Mailing Address - Fax:
Practice Address - Street 1:613 NIMROD CT
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1501
Practice Address - Country:US
Practice Address - Phone:631-805-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-19
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002880103K00000X
NY093453-1104100000X
NY091844-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker