Provider Demographics
NPI:1639831399
Name:HARRIS, MICHAEL REID (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:REID
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BROOKFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1444
Mailing Address - Country:US
Mailing Address - Phone:631-736-8362
Mailing Address - Fax:
Practice Address - Street 1:755 WAVERLY AVE STE 216
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1125
Practice Address - Country:US
Practice Address - Phone:631-487-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113941104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker