Healthcare Provider Details

I. General information

NPI: 1730336710
Provider Name (Legal Business Name): MICHAEL SEAN HARRIS PH.D., M.DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 AMITY RD
BETHANY CT
06524-3407
US

IV. Provider business mailing address

350 AMITY RD
BETHANY CT
06524-3407
US

V. Phone/Fax

Practice location:
  • Phone: 541-517-4908
  • Fax:
Mailing address:
  • Phone: 541-517-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3601
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: