Provider Demographics
NPI:1790199529
Name:HARRITY, MEGAN (PHD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HARRITY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 E JEFFERSON BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3112
Mailing Address - Country:US
Mailing Address - Phone:574-289-9700
Mailing Address - Fax:
Practice Address - Street 1:919 E JEFFERSON BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3112
Practice Address - Country:US
Practice Address - Phone:574-289-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042579A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist