Provider Demographics
NPI:1265519029
Name:HARRIS, CATHY SUE (LCSW)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:SUE
Last Name: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 1:5050 NIAGARA AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3027
Mailing Address - Country:US
Mailing Address - Phone:619-807-9159
Mailing Address - Fax:619-324-4192
Practice Address - Street 1:3679 VOLTAIRE ST STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-1252
Practice Address - Country:US
Practice Address - Phone:619-807-9159
Practice Address - Fax:619-324-4192
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS283181041C0700X
TX581281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA36996OtherBCBS/WELLMARK OF IOWA
CA11990912OtherCAQH
IA1459909Medicaid
IA244574OtherMIDLANDS CHOICE
IA737362000OtherMAGELLAN/TITLE 19
IA244574OtherMIDLANDS CHOICE