Provider Demographics
NPI:1770367674
Name:HARRIS, KENDRICK DIONDRE
Entity type:Individual
Prefix:
First Name:KENDRICK
Middle Name:DIONDRE
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 1:1006 35TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-4559
Mailing Address - Country:US
Mailing Address - Phone:941-909-5072
Mailing Address - Fax:
Practice Address - Street 1:1006 35TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-4559
Practice Address - Country:US
Practice Address - Phone:941-909-5072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician