Provider Demographics
NPI:1518667534
Name:HARRIGAN, IESA MARIE (MS, CRC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:IESA
Middle Name:MARIE
Last Name:HARRIGAN
Suffix:
Gender:F
Credentials:MS, CRC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 KENT AVE
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5900
Mailing Address - Country:US
Mailing Address - Phone:607-427-9454
Mailing Address - Fax:607-239-4994
Practice Address - Street 1:214 KENT AVE
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-5900
Practice Address - Country:US
Practice Address - Phone:607-427-9454
Practice Address - Fax:607-239-4994
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101YM0800XMedicaid