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General NPI Number Information
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NPI Number | 1700994696
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Entity Type | Individual
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Provider Name | FREDRIC ALAN HARRIS
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 27 W 96TH ST
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City | NEW YORK
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State | NY
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Zip | 10025-6607
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Country | US
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Telephone | 732-272-3046
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Fax |
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Provider Business Mailing Address
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Address Line | 23 FARMEDGE LN
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City | TINTON FALLS
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State | NJ
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Zip | 07724-2705
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Country | US
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Telephone | 732-272-3046
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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 | 6175
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License Number State | NY
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