Individual ProviderHarrison MarshallSocial WorkerBehavioral Health & Social Service ProvidersPractice Address21 Bloomingdale Rd, White Plains, NY 10605-1504(914) 997-4366(914) 773-7314PECOS EnrollmentBased on the most recent information from CMS, provider Harrison Marshall does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1790125359Provider TypeIndividualFull NameMarshall, HarrisonGenderMaleSole ProprietorYesEnumeration Date6/27/2013Last Updated3/12/2020Contact InformationPractice LocationPractice Address21 Bloomingdale Rd, White Plains, NY 10605-1504Phone(914) 997-4366FaxUnlisted FaxMailing LocationMailing Address226 Linda Ave, Hawthorne, NY 10532-2018Phone(914) 773-7314FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense095591New YorkCode104100000XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID02449154DescriptionMedicaidIssuerUnlistedNew YorkID1285628552DescriptionOtherIssuerAGENCYNew YorkIDWVE061DescriptionOtherIssuerMEDICARE #New York