Provider Demographics
NPI:1952463416
Name:HARRIS, SUSAN KAY (LIC AC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LIC AC
Mailing Address - Street 1:9 HILLSVIEW STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021
Mailing Address - Country:US
Mailing Address - Phone:781-344-0720
Mailing Address - Fax:
Practice Address - Street 1:9 HILLSVIEW ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1314
Practice Address - Country:US
Practice Address - Phone:781-344-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist