Provider Demographics
NPI:1780303321
Name:STEPHANIE HARRIS LCSW LADC LLC
Entity type:Organization
Organization Name:STEPHANIE HARRIS LCSW LADC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADC
Authorized Official - Phone:203-600-2951
Mailing Address - Street 1:609 W JOHNSON AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-4505
Mailing Address - Country:US
Mailing Address - Phone:203-600-2951
Mailing Address - Fax:
Practice Address - Street 1:609 W JOHNSON AVE STE 310
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-4505
Practice Address - Country:US
Practice Address - Phone:203-600-2951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11409OtherSTATE LICENSE