MEDICARE: JUSTINE A. HARRIS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC04647500	NJ

General Provider Information

NPI Number	:	1154359032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE A. HARRIS LCSW

Provider Business Mailing Address
First Line	:	2421 ATLANTIC AVE
Second Line	:	STE 102
City	:	MANASQUAN
State	:	NJ
Zip	:	08736-1000
Country	:	US
Telephone Number	:	732-349-1977
Fax Number	:	732-349-0841

Provider Business Practice Location Address
First Line	:	160 ATLANTIC CITY BLVD
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-1229
Country	:	US
Telephone Number	:	732-349-1977
Fax Number	:	732-349-0841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	02/01/2019

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