Provider Demographics
NPI:1588989701
Name:HARRIS, EMILY W (MS BCBA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:W
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:162 WEST ST
Mailing Address - Street 2:BUILDING 2, SUITE F
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-4404
Mailing Address - Country:US
Mailing Address - Phone:860-613-9930
Mailing Address - Fax:203-810-4953
Practice Address - Street 1:162 WEST ST
Practice Address - Street 2:BUILDING 2, SUITE F
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-4404
Practice Address - Country:US
Practice Address - Phone:860-613-9930
Practice Address - Fax:203-810-4953
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-08-4428103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst