Healthcare Provider Details

I. General information

NPI: 1720539943
Provider Name (Legal Business Name): ANITA B HARRIS CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 AIRPORT RD
FITCHBURG MA
01420-8142
US

IV. Provider business mailing address

155 AIRPORT RD
FITCHBURG MA
01420-8142
US

V. Phone/Fax

Practice location:
  • Phone: 978-643-4300
  • Fax:
Mailing address:
  • Phone: 978-643-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1023175072
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: