Provider Demographics
NPI:1710598982
Name:HARRIS, AMANDA VIOLA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:VIOLA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 PINECREST CT
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1405
Mailing Address - Country:US
Mailing Address - Phone:570-762-6176
Mailing Address - Fax:
Practice Address - Street 1:1045 W GLEN OAKS LN STE 1
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3477
Practice Address - Country:US
Practice Address - Phone:262-241-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020083103T00000X
WI3897-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist