Provider Demographics
NPI:1396235503
Name:HARRIS, ERIC A (EDD, JD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:M
Credentials:EDD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-2707
Mailing Address - Country:US
Mailing Address - Phone:781-883-4049
Mailing Address - Fax:
Practice Address - Street 1:138 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-2707
Practice Address - Country:US
Practice Address - Phone:781-883-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2451-PY-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical