Provider Demographics
NPI:1982805032
Name:HARRIS, BRIAN TIMOTHY (MT-BC, LCAT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:TIMOTHY
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 PROSPECT AVE
Mailing Address - Street 2:#1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5853
Mailing Address - Country:US
Mailing Address - Phone:646-671-4865
Mailing Address - Fax:
Practice Address - Street 1:437 PROSPECT AVE
Practice Address - Street 2:#1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5853
Practice Address - Country:US
Practice Address - Phone:646-671-4865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000952-1225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist