Provider Demographics
NPI:1003582677
Name:HARRIS, BREIANNA DIANA (LCPAT)
Entity type:Individual
Prefix:MS
First Name:BREIANNA
Middle Name:DIANA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCPAT
Other - Prefix:MS
Other - First Name:BREIANNA
Other - Middle Name:DIANA
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPAT
Mailing Address - Street 1:4C NORTH AVE STE 423
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2334
Mailing Address - Country:US
Mailing Address - Phone:410-449-4955
Mailing Address - Fax:
Practice Address - Street 1:1220 E JOPPA RD BLDG B
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5811
Practice Address - Country:US
Practice Address - Phone:410-449-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist