Provider Demographics
NPI:1033749148
Name:HARRIS, AMALIA MARIA (MAED, SCLIDP)
Entity Type:Individual
Prefix:
First Name:AMALIA
Middle Name:MARIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MAED, SCLIDP
Other - Prefix:
Other - First Name:AMALIA
Other - Middle Name:MARIA
Other - Last Name:BRUSHART HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAED
Mailing Address - Street 1:530 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-6009
Mailing Address - Country:US
Mailing Address - Phone:270-933-2273
Mailing Address - Fax:844-857-1496
Practice Address - Street 1:530 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6009
Practice Address - Country:US
Practice Address - Phone:270-933-2273
Practice Address - Fax:844-857-1496
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management