Provider Demographics
NPI:1144359589
Name:HARRIS, ROSALIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:
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 1:67 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1731
Mailing Address - Country:US
Mailing Address - Phone:516-466-3563
Mailing Address - Fax:516-466-2781
Practice Address - Street 1:67 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1731
Practice Address - Country:US
Practice Address - Phone:516-466-3563
Practice Address - Fax:516-466-2781
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0625091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY062509OtherNEW YORK STATE LICENSE