Provider Demographics
NPI:1376114934
Name:HARSHAW, DENNAE MALESA
Entity Type:Individual
Prefix:
First Name:DENNAE
Middle Name:MALESA
Last Name:HARSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 SMALLWOOD DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1337
Mailing Address - Country:US
Mailing Address - Phone:323-487-2492
Mailing Address - Fax:
Practice Address - Street 1:60 PLAZA ST E APT 1G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5030
Practice Address - Country:US
Practice Address - Phone:323-487-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical