MEDICARE: ELIZABETH HARRIS M.A., BCBA, LBA

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	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst	0133001911	VA

General Provider Information

NPI Number	:	1518472448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HARRIS M.A., BCBA, LBA

Provider Business Mailing Address
First Line	:	312 MANNING LN
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-5021
Country	:	US
Telephone Number	:	757-719-3472
Fax Number	:

Provider Business Practice Location Address
First Line	:	12610 PATRICK HENRY DR STE M
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23602-9538
Country	:	US
Telephone Number	:	757-817-0089
Fax Number	:

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

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	08/05/2025

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