Provider Demographics
NPI:1083220263
Name:HARRIS, KAMIL DEANDRE (MS)
Entity Type:Individual
Prefix:
First Name:KAMIL
Middle Name:DEANDRE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5657
Mailing Address - Country:US
Mailing Address - Phone:412-918-6734
Mailing Address - Fax:
Practice Address - Street 1:1242 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5657
Practice Address - Country:US
Practice Address - Phone:412-918-6734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)