Provider Demographics
NPI:1962561803
Name:HARRIS, ROBERT SAMUEL (MSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SAMUEL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 DWIGHT RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1761
Mailing Address - Country:US
Mailing Address - Phone:413-567-9993
Mailing Address - Fax:413-567-9993
Practice Address - Street 1:175 DWIGHT RD
Practice Address - Street 2:SUITE 303
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1761
Practice Address - Country:US
Practice Address - Phone:413-567-9993
Practice Address - Fax:413-567-9993
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1056991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03971OtherBC BS PROVIDER NUMBER
MAP03971Medicare ID - Type UnspecifiedPROVIDER NUMBER