Provider Demographics
NPI:1336335751
Name:HARRIS, MEGHAN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:A
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:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94966-1805
Mailing Address - Country:US
Mailing Address - Phone:415-215-4924
Mailing Address - Fax:
Practice Address - Street 1:3030 BRIDGEWAY
Practice Address - Street 2:STE 410
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2810
Practice Address - Country:US
Practice Address - Phone:415-215-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical