Provider Demographics
NPI:1518236827
Name:HARRIS, MELISSA
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
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 1:392 SEGUINE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3906
Mailing Address - Country:US
Mailing Address - Phone:718-226-2808
Mailing Address - Fax:718-226-2920
Practice Address - Street 1:392 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3906
Practice Address - Country:US
Practice Address - Phone:718-226-2808
Practice Address - Fax:718-226-2920
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2023-06-22
Deactivation Date:2023-04-18
Deactivation Code:
Reactivation Date:2023-06-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)