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General NPI Number Information
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NPI Number | 1659548725
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Entity Type | Individual
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Provider Name | RANDALL JAY HARRIS PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 1765 GOUCHER ST
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City | JOHNSTOWN
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State | PA
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Zip | 15905-1101
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Country | US
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Telephone | 814-535-8586
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Fax |
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Provider Business Mailing Address
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Address Line | 349 N MCKEAN ST
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City | BUTLER
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State | PA
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Zip | 16001-4928
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Country | US
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Telephone | 814-535-8586
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS017283
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License Number State | PA
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