Provider Demographics
NPI:1396465357
Name:HARRISON, CHAUNCEY RACHAEL SHERWOOD (LMSW)
Entity type:Individual
Prefix:
First Name:CHAUNCEY
Middle Name:RACHAEL SHERWOOD
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5354
Mailing Address - Country:US
Mailing Address - Phone:917-941-4983
Mailing Address - Fax:
Practice Address - Street 1:354 E 91ST ST APT 802
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0055
Practice Address - Country:US
Practice Address - Phone:917-941-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002350225600000X
NY11871401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist