Provider Demographics
NPI:1023051901
Name:NYMAN HARRIS, MICHELE N (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:N
Last Name:NYMAN HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YALE-NEW HAVEN HOSPITAL
Mailing Address - Street 2:20 YORK STREET
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06504
Mailing Address - Country:US
Mailing Address - Phone:203-688-5480
Mailing Address - Fax:203-688-3596
Practice Address - Street 1:YALE-NEW HAVEN HOSPITAL
Practice Address - Street 2:20 YORK STREET
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06504
Practice Address - Country:US
Practice Address - Phone:203-688-5480
Practice Address - Fax:203-688-3596
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003766Medicare ID - Type Unspecified