=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043305741
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET HARRIS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2505 MAIN ST SUITE 208
-----------------------------------------------------
City | STRATFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06615-5839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-386-0364
-----------------------------------------------------
Fax | 203-386-0364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 CORNERSTONE DR
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06418-1145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-735-3038
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 003348
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------