Provider Demographics
NPI:1700994696
Name:HARRIS, FREDRIC ALAN
Entity Type:Individual
Prefix:
First Name:FREDRIC
Middle Name:ALAN
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 1:110 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:970 ROUTE 70
Practice Address - Street 2:HOWARD OUTPATIENT CLINIC
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3502
Practice Address - Country:US
Practice Address - Phone:732-206-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6175103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical