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NPI Code Detail

MEDICARE: JACQUELINE HARRIS

MEDICARE: JACQUELINE HARRIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerP138307NY

General Provider Information

NPI Number : 1568315828
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE HARRIS
Provider Business Mailing Address
First Line : 371 N COLUMBUS AVE
Second Line :
City : FREEPORT
State : NY
Zip : 11520-1242
Country : US
Telephone Number : 631-609-7618
Fax Number :
Provider Business Practice Location Address
First Line : 151 BURRS LN
Second Line :
City : DIX HILLS
State : NY
Zip : 11746-6052
Country : US
Telephone Number : 631-609-7618
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2026
Last Update Date : 02/17/2026

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Directions to “ JACQUELINE HARRIS ” Practice Location

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