Provider Demographics
NPI:1043694292
Name:HARRIS, MARY KATHERINE (SP EDUCATION TEACHER)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHERINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:SP EDUCATION TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NETHERLAND AVE
Mailing Address - Street 2:APARTMENT 1G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3410
Mailing Address - Country:US
Mailing Address - Phone:646-522-1747
Mailing Address - Fax:
Practice Address - Street 1:3200 NETHERLAND AVE
Practice Address - Street 2:APARTMENT 1G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3410
Practice Address - Country:US
Practice Address - Phone:646-522-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist