Provider Demographics
NPI:1518642198
Name:HARNESS, ERIN IRENE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:IRENE
Last Name:HARNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 GUERNEVILLE RD STE 14
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-4191
Mailing Address - Country:US
Mailing Address - Phone:707-575-0979
Mailing Address - Fax:
Practice Address - Street 1:1410 GUERNEVILLE RD STE 14
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-4191
Practice Address - Country:US
Practice Address - Phone:707-575-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health