Provider Demographics
NPI:1043503501
Name:HARRISON, MICHAEL G
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:HARRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 FRIENDLY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6312
Mailing Address - Country:US
Mailing Address - Phone:516-849-0800
Mailing Address - Fax:
Practice Address - Street 1:72 FRIENDLY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6312
Practice Address - Country:US
Practice Address - Phone:516-849-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health