Individual
MS. PENNY WILBUR-HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
15 BROOKFIELD LN, SOUTH SETAUKET, NY 11720-1444
(631) 553-8469
Mailing address
15 BROOKFIELD LN, SOUTH SETAUKET, NY 11720-1444
(631) 553-8469
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
R027333
NY
1041S0200X
School Social Worker
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11238224
CAQH
MO
01
—
145126
VALUE OPTIONS
NY
01
—
4281184
AETNA
TX
01
—
IP322152
EMPIRE BC/BS
NY
01
—
P75660
OXFORD
CT
Enumeration date
09/24/2006
Last updated
09/11/2025
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