Provider Demographics
NPI:1073088795
Name:HARRIS, TASHARNI (LCSW)
Entity type:Individual
Prefix:
First Name:TASHARNI
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TASHARNI
Other - Middle Name:
Other - Last Name:HARRIS-PALACHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:614 GRIMM PL
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3029
Mailing Address - Country:US
Mailing Address - Phone:518-506-3930
Mailing Address - Fax:
Practice Address - Street 1:338 BLANCO DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-1021
Practice Address - Country:US
Practice Address - Phone:631-874-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0827161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical