Provider Demographics
NPI:1891589867
Name:HARRISON, KEISHA CHANTEL
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:CHANTEL
Last Name:HARRISON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ANNUNCIATION RD
Mailing Address - Street 2:APT 2560
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-1800
Mailing Address - Country:US
Mailing Address - Phone:857-492-1055
Mailing Address - Fax:
Practice Address - Street 1:80 ANNUNCIATION RD
Practice Address - Street 2:APT 2560
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-1800
Practice Address - Country:US
Practice Address - Phone:857-492-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician