Provider Demographics
NPI:1174693022
Name:HARRIS, DAVID R (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 ORCHID ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:941-951-0548
Mailing Address - Fax:941-955-6269
Practice Address - Street 1:1808 ORCHID ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-951-0548
Practice Address - Fax:941-955-6269
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW22131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8000010415OtherMEDICARE RAILROAD RETIRE
FLZ3772OtherBCBS OF FLORIDA
FLZ3772OtherBCBS OF FLORIDA