Healthcare Provider Details

I. General information

NPI: 1710460910
Provider Name (Legal Business Name): STACY HARRIS LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 PROSPECT ST
FALL RIVER MA
02720-3415
US

IV. Provider business mailing address

2 SLEEPY HOLLOW CIR
NORTH ATTLEBORO MA
02760-3555
US

V. Phone/Fax

Practice location:
  • Phone: 508-674-4847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: