Amanda Viola Harris, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3897-57 Issued in WI

Practice address

1045 W Glen Oaks LN Ste 1
Mequon, WI 53092-3477

Phone

(262) 241-8100

NPI assigned

Aug 12, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, PA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Abloom Psychological Services, PLLC

  • Community/Behavioral Health Agency
  • Murrysville, PA
  • NPI 1558113969
  Medicare reassignment NPD Authorized official
• Mequon Clinical Associates, SC

  • Psychiatry Physician
  • Mequon, WI
  • NPI 1326296518

  Mental Health

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1710598982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 PINECREST CT",
            "city": "MURRYSVILLE",
            "state": "PA",
            "postal_code": "156681405",
            "telephone_number": "570-762-6176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 W GLEN OAKS LN STE 1",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923477",
            "telephone_number": "262-241-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4520 Old William Penn Hwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Murrysville",
            "state": "PA",
            "postal_code": "156681907",
            "country_code": "US",
            "telephone_number": "724-882-2339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "AMANDA",
        "middle_name": "VIOLA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-12",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS020083",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3897-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Allyce Hanson, HIS
• Patricia Mary Harkensee, OTR
• Michelle Harmon, RN
• Harmony Heaven Care LLC
• Harrigan Development Services
• Annette S Harris, NP
• Lois Harrison
• Kenneth Hartenstein, LPC
• Carly Hartman, PHARM.D.
• Haili Hartmann

• Psychologist in Mequon, WI
• Providers in Mequon, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.