Provider Demographics
NPI:1093317323
Name:HARRIS, ALBERTA II
Entity Type:Individual
Prefix:MS
First Name:ALBERTA
Middle Name:
Last Name:HARRIS
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BAYVIEW AVE STE 2FLOOR
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4204
Mailing Address - Country:US
Mailing Address - Phone:347-485-2160
Mailing Address - Fax:
Practice Address - Street 1:22 BAYVIEW AVE STE 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-4204
Practice Address - Country:US
Practice Address - Phone:347-485-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA886476741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ84-4408160Medicaid