Healthcare Provider Details

I. General information

NPI: 1477655058
Provider Name (Legal Business Name): ANNE RANDOLPH HARRIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 COURT ST
PLYMOUTH MA
02360-4037
US

IV. Provider business mailing address

232 COURT ST
PLYMOUTH MA
02360-4037
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-2718
  • Fax: 508-747-5209
Mailing address:
  • Phone: 508-747-2718
  • Fax: 508-747-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6091
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: