Healthcare Provider Details

I. General information

NPI: 1194296418
Provider Name (Legal Business Name): JESSICA E HARRISON, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2018
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E INDIANTOWN RD STE 310
JUPITER FL
33477-5153
US

IV. Provider business mailing address

21000 PORTOFINO CIR APT 125
PALM BEACH GARDENS FL
33418-1262
US

V. Phone/Fax

Practice location:
  • Phone: 954-600-6695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA EMILY HARRISON
Title or Position: PRESIDENT
Credential: LCSW
Phone: 954-600-6695