Provider Demographics
NPI:1467620138
Name:HARRIS, SCOTT KEITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KEITH
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 CUDAHY PL STE 314
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3924
Mailing Address - Country:US
Mailing Address - Phone:619-276-8112
Mailing Address - Fax:619-276-8230
Practice Address - Street 1:1094 CUDAHY PL STE 314
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3924
Practice Address - Country:US
Practice Address - Phone:619-276-8112
Practice Address - Fax:619-276-8230
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22416103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical