Healthcare Provider Details

I. General information

NPI: 1124622014
Provider Name (Legal Business Name): JESSICA ANN HARRISON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WASHINGTON AVE
HALETHORPE MD
21227-3115
US

IV. Provider business mailing address

5062 JUDICIAL WAY
FREDERICK MD
21703-4807
US

V. Phone/Fax

Practice location:
  • Phone: 667-600-3984
  • Fax: 667-600-4065
Mailing address:
  • Phone: 908-227-8864
  • Fax: 667-600-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21961
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: