Provider Demographics
NPI:1003176595
Name:HARRIS, VIRGINIA SYDNESS (CSB)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SYDNESS
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CSB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GROVE ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7702
Mailing Address - Country:US
Mailing Address - Phone:781-235-9350
Mailing Address - Fax:781-235-9365
Practice Address - Street 1:40 GROVE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7702
Practice Address - Country:US
Practice Address - Phone:781-235-9350
Practice Address - Fax:781-235-9365
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner