MEDICARE: ROBERT E HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-332808	VA

General Provider Information

NPI Number	:	1043018120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT E HARRIS

Provider Business Mailing Address
First Line	:	1446 KEMPSVILLE RD STE 203
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1446 KEMPSVILLE RD STE 203
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7300
Country	:	US
Telephone Number	:	757-639-7919
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	03/05/2025

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