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NPI Code Detail

MEDICARE: JACQUELINE D FAISON-HARRY PHD

MEDICARE: JACQUELINE D FAISON-HARRY PHD
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
1103T00000XPsychologist022357NY

General Provider Information

NPI Number : 1619496478
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE D FAISON-HARRY PHD
Provider Business Mailing Address
First Line : 5769 GALLOPING DR
Second Line :
City : APOPKA
State : FL
Zip : 32712-6085
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 600 N LOOP 1604 E
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78232-1268
Country : US
Telephone Number : 210-239-0066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2017
Last Update Date : 08/08/2025

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