Provider Demographics
NPI:1457658122
Name:HARRIS, IRINA R (LCSW)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:R
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 1:400 E 56TH ST
Mailing Address - Street 2:#18O
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4147
Mailing Address - Country:US
Mailing Address - Phone:212-308-3285
Mailing Address - Fax:
Practice Address - Street 1:611 BROADWAY
Practice Address - Street 2:SUITE# 908
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2608
Practice Address - Country:US
Practice Address - Phone:646-206-5196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069971-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical