Provider Demographics
NPI:1700036720
Name:HARRIS-DAVID, LARA R (LICSW)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:R
Last Name:HARRIS-DAVID
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:HARRIS-DAVID LICSW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:111 OLD ROAD TO 9 ACRE COR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4141
Mailing Address - Country:US
Mailing Address - Phone:978-369-1113
Mailing Address - Fax:
Practice Address - Street 1:47 GATES LN
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:MA
Practice Address - Zip Code:01775-1203
Practice Address - Country:US
Practice Address - Phone:978-793-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical