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General NPI Number Information
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NPI Number | 1518438852
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Entity Type | Organization
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Legal Business Name | JESSICA E HARRISON, LCSW
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 900 EAST INDIANTOWN ROAD 310
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418
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Country | US
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Telephone | 954-600-6695
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Fax |
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Provider Business Mailing Address
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Address Line | 21000 PORTOFINO CIR APT 125
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-1262
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JESSICA EMILY HARRISON
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Credential | LCSW
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Telephone | 954-600-6695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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