Provider Demographics
NPI:1770205122
Name:HARRIS, FALASADE (LAC)
Entity type:Individual
Prefix:
First Name:FALASADE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CLYDE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5037
Mailing Address - Country:US
Mailing Address - Phone:848-999-0123
Mailing Address - Fax:
Practice Address - Street 1:13 CLYDE RD STE 103
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5037
Practice Address - Country:US
Practice Address - Phone:848-999-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional