Provider Demographics
NPI:1780885426
Name:HARRIS, STEPHANIE JOY (PSYD, CHTP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JOY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PSYD, CHTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FRONT ST APT 243
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6734
Mailing Address - Country:US
Mailing Address - Phone:305-632-8706
Mailing Address - Fax:
Practice Address - Street 1:2535 CAMINO DEL RIO S STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3795
Practice Address - Country:US
Practice Address - Phone:305-632-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6881103TC0700X
CAPSY28876103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical