Provider Demographics
NPI:1427492297
Name:HARRISON, KATE ELIZABETH (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:KATE
Middle Name:ELIZABETH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:ELIZABETH
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2630
Mailing Address - Country:US
Mailing Address - Phone:703-220-4678
Mailing Address - Fax:
Practice Address - Street 1:20 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2630
Practice Address - Country:US
Practice Address - Phone:703-220-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-13-5302103K00000X
VA1-14-15838103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427492297Medicaid