Provider Demographics
NPI:1568602027
Name:HARRIS, RICHARD (PSYD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
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:DEPARTMENT OF VETERANS AFFAIRS
Mailing Address - Street 2:881 MAIN ST.
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3057
Mailing Address - Country:US
Mailing Address - Phone:978-342-9781
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS
Practice Address - Street 2:881 MAIN ST.
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-3057
Practice Address - Country:US
Practice Address - Phone:978-342-9781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK682103T00000X
MA11470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1624584Medicaid
AKK166095Medicare PIN