Provider Demographics
NPI:1386207652
Name:HARRIS, ASHLEY CHANELL
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CHANELL
Last Name:HARRIS
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 1:55 WASHINGTON ST STE 552
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1089
Mailing Address - Country:US
Mailing Address - Phone:347-401-1399
Mailing Address - Fax:
Practice Address - Street 1:76 CENTER ST FL 3
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2129
Practice Address - Country:US
Practice Address - Phone:347-401-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT105661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical