Provider Demographics
NPI:1417749474
Name:HARRIS, DANIEL E
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 BROAD ST STE 1002
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1479
Mailing Address - Country:US
Mailing Address - Phone:401-215-7569
Mailing Address - Fax:401-215-7569
Practice Address - Street 1:570 BROAD ST STE 1002
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1479
Practice Address - Country:US
Practice Address - Phone:401-215-7569
Practice Address - Fax:401-215-7569
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker