Provider Demographics
NPI:1770630717
Name:HARRIS, PAUL VIVIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VIVIAN
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 1:1927 N MOHAWK ST
Mailing Address - Street 2:UNIT #A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5219
Mailing Address - Country:US
Mailing Address - Phone:312-263-1388
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 734
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7712
Practice Address - Country:US
Practice Address - Phone:312-729-5044
Practice Address - Fax:312-729-5099
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001633868OtherBLUE CROSS BLUE SHIELD