Provider Demographics
NPI:1508526930
Name:HARRIS, YVONNE MARIE (LSW)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARIE
Last Name: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 1:14 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5936
Mailing Address - Country:US
Mailing Address - Phone:973-202-4661
Mailing Address - Fax:
Practice Address - Street 1:27 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2604
Practice Address - Country:US
Practice Address - Phone:732-825-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06328800101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL06328800OtherNJ OFFICE OF THE ATTORNEY GENERAL, DIVISION OF CONSUMER AFFAIRS