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General NPI Number Information
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NPI Number | 1952729972
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Entity Type | Individual
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Provider Name | JESSIE HARRIS
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Gender | Female
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 7 CLAYTON AVE
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City | CORTLAND
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State | NY
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Zip | 13045-2501
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Country | US
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Telephone | 607-758-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 205 HAZEL DR
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City | VESTAL
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State | NY
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Zip | 13850-3115
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Country | US
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Telephone | 607-348-3618
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 078689-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 086716
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License Number State | NY
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