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General NPI Number Information
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NPI Number | 1619496478
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Entity Type | Individual
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Provider Name | JACQUELINE D FAISON-HARRY PHD
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Gender | Female
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 600 N LOOP 1604 E
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1268
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Country | US
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Telephone | 210-239-0066
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Fax |
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Provider Business Mailing Address
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Address Line | 5769 GALLOPING DR
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City | APOPKA
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State | FL
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Zip | 32712-6085
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 022357
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License Number State | NY
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