Frederic G Harris

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

064123 Issued in NY

Practice address

90 Hull Ave
Clintondale, NY 12515-5110

Phone

(845) 883-0392

NPI assigned

Jan 24, 2018

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 17, 2018.

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1891293866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 HULL AVE",
            "city": "CLINTONDALE",
            "state": "NY",
            "postal_code": "125155110",
            "telephone_number": "845-883-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HULL AVE",
            "city": "CLINTONDALE",
            "state": "NY",
            "postal_code": "125155110",
            "telephone_number": "845-883-0392"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Grand St Ste 3",
            "address_purpose": "LOCATION",
            "city": "Kingston",
            "state": "NY",
            "postal_code": "124013933",
            "country_code": "US",
            "telephone_number": "845-282-5201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "FREDERIC",
        "middle_name": "G",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "064123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlyn Margaret Callahan
• Yue Chen
• Hope K Cruz, LPN
• Michelle Yvonne Eckert, CCC-SLP
• Aron Marie Harrington, RN
• Amanda Krom
• Felicia Lassiter, RN
• Robert P Oculato, DDS
• Kathleen Scott
• Alec Shneider, PTA

• All providers in Clintondale, NY
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.