Provider Demographics
NPI:1881404200
Name:HARBORSIDE PSYCHIATRY, LLC
Entity type:Organization
Organization Name:HARBORSIDE PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KACIE
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPMHNP
Authorized Official - Phone:541-714-5610
Mailing Address - Street 1:213 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-9100
Mailing Address - Country:US
Mailing Address - Phone:541-714-5610
Mailing Address - Fax:541-714-5611
Practice Address - Street 1:213 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9100
Practice Address - Country:US
Practice Address - Phone:541-714-5610
Practice Address - Fax:541-714-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty