Healthcare Provider Details

I. General information

NPI: 1508897802
Provider Name (Legal Business Name): SEAN HARRIS LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 WESTFIELD ST
WEST SPRINGFIELD MA
01089-3878
US

IV. Provider business mailing address

10 OLD FARM RD
BRIDGEWATER MA
02324-3448
US

V. Phone/Fax

Practice location:
  • Phone: 413-592-1980
  • Fax: 413-439-0096
Mailing address:
  • Phone: 508-697-2754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1029847
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: