Provider Demographics
NPI:1831594167
Name:HARRIS, SAMANTHA LEAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LEAH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:914 S ROBERTSON BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1600
Mailing Address - Country:US
Mailing Address - Phone:424-257-3892
Mailing Address - Fax:
Practice Address - Street 1:914 S ROBERTSON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1600
Practice Address - Country:US
Practice Address - Phone:424-257-3892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical