Provider Demographics
NPI:1942843776
Name:HARRISON, TYRA DANIELLE
Entity Type:Individual
Prefix:
First Name:TYRA
Middle Name:DANIELLE
Last Name:HARRISON
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 1:2990 VERITY LN
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4553
Mailing Address - Country:US
Mailing Address - Phone:516-469-7708
Mailing Address - Fax:
Practice Address - Street 1:2990 VERITY LN
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4553
Practice Address - Country:US
Practice Address - Phone:516-469-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst