Provider Demographics
NPI:1497203848
Name:GHAEMAGHAMY-HARRIS, MINDY (LSW)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:
Last Name:GHAEMAGHAMY-HARRIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221B PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2954
Mailing Address - Country:US
Mailing Address - Phone:814-746-8433
Mailing Address - Fax:
Practice Address - Street 1:2221B PENINSULA DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2954
Practice Address - Country:US
Practice Address - Phone:814-746-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health