Provider Demographics
NPI:1386254076
Name:ELEAZER HARRIS, TIMIA ROCHELLE
Entity type:Individual
Prefix:
First Name:TIMIA
Middle Name:ROCHELLE
Last Name:ELEAZER HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 DORY BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3865
Mailing Address - Country:US
Mailing Address - Phone:443-771-2896
Mailing Address - Fax:
Practice Address - Street 1:8 BAYSIDE DR
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-4912
Practice Address - Country:US
Practice Address - Phone:443-771-2896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst