Provider Demographics
NPI:1497280895
Name:HARRIS, KRISTINE ELIZABETH (MSSA, LSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:FEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:16702 SEDALIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-4458
Mailing Address - Country:US
Mailing Address - Phone:330-635-7992
Mailing Address - Fax:
Practice Address - Street 1:10427 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1645
Practice Address - Country:US
Practice Address - Phone:216-696-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600990104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHW234280275OtherAETNA