Provider Demographics
NPI:1528126380
Name:HARRIS, EVA (LICSW)
Entity type:Individual
Prefix:MS
First Name:EVA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KINNAIRD ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3733
Mailing Address - Country:US
Mailing Address - Phone:617-261-4858
Mailing Address - Fax:617-868-8680
Practice Address - Street 1:67 BROAD ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4826
Practice Address - Country:US
Practice Address - Phone:617-261-4858
Practice Address - Fax:617-868-8680
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10258751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical