Active NPI
Michael Reid Harris, LMSW
- Social Worker
- Holtsville, NY
National Provider Identifier
1639831399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 113941
- Practice address
- 755 Waverly Ave Ste 216
Holtsville, NY 11742-1125 - Phone
- (631) 487-8181
- NPI assigned
- Oct 11, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 113941 | NY | Primary |
Addresses
Primary practice location
755 Waverly Ave Ste 216
Holtsville, NY 11742-1125
Mailing address
15 Brookfield LN
South Setauket, NY 11720-1444
Phone (631) 736-8362
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113941 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633910400000",
"number": "1639831399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 BROOKFIELD LN",
"city": "SOUTH SETAUKET",
"state": "NY",
"postal_code": "117201444",
"telephone_number": "631-736-8362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 WAVERLY AVE STE 216",
"city": "HOLTSVILLE",
"state": "NY",
"postal_code": "117421125",
"telephone_number": "631-487-8181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "MICHAEL",
"middle_name": "REID",
"name_prefix": "Mr.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-10-11",
"last_updated": "2021-10-11",
"certification_date": "2021-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "113941",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holtsville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.