1225112295 NPI number — MS. ROBERTA HARRIS- MORAN L-CSW

Table of content: MS. ROBERTA HARRIS- MORAN L-CSW (NPI 1225112295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225112295 NPI number — MS. ROBERTA HARRIS- MORAN L-CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS- MORAN
Provider First Name:
ROBERTA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L-CSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRIS- MORAN
Provider Other First Name:
BARBARA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L-CSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225112295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1837 HERTEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14216-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-834-5114
Provider Business Mailing Address Fax Number:
716-834-1010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1837 HERTEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-834-5114
Provider Business Practice Location Address Fax Number:
716-834-5116
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  L033962-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 074440564 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6190173 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00511001001 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00025069101 . This is a "UNIVERVA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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