Provider Demographics
NPI:1992760839
Name:HARRIS, ALEXANDRA MARVIN (PHD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARVIN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 ALTA MEADOWS LN
Mailing Address - Street 2:SUITE 1612
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-1171
Mailing Address - Country:US
Mailing Address - Phone:561-276-1998
Mailing Address - Fax:561-276-1998
Practice Address - Street 1:2040 ALTA MEADOWS LN
Practice Address - Street 2:SUITE 1612
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-1171
Practice Address - Country:US
Practice Address - Phone:561-276-1998
Practice Address - Fax:561-276-1998
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4798103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL211232900Medicaid