Healthcare Provider Details

I. General information

NPI: 1255274320
Provider Name (Legal Business Name): JAMIE HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 BLACKPOOL PL
SAN LEANDRO CA
94577-6045
US

IV. Provider business mailing address

2315 BLACKPOOL PL
SAN LEANDRO CA
94577-6045
US

V. Phone/Fax

Practice location:
  • Phone: 510-603-5505
  • Fax:
Mailing address:
  • Phone: 510-603-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220146001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: