Provider Demographics
NPI:1801212253
Name:HARRIS-MILLER, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HARRIS-MILLER
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 1:94 DANIEL RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2208
Mailing Address - Country:US
Mailing Address - Phone:203-675-3099
Mailing Address - Fax:203-596-7091
Practice Address - Street 1:94 DANIEL RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-2208
Practice Address - Country:US
Practice Address - Phone:203-675-3099
Practice Address - Fax:203-596-7091
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0053491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical