Provider Demographics
NPI:1225687585
Name:HARRIS, JAINA (BS)
Entity Type:Individual
Prefix:MRS
First Name:JAINA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MISS
Other - First Name:JAINA
Other - Middle Name:
Other - Last Name:MAIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:205 WAKELEE AVE
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1234
Mailing Address - Country:US
Mailing Address - Phone:203-735-7481
Mailing Address - Fax:
Practice Address - Street 1:205 WAKELEE AVE
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1234
Practice Address - Country:US
Practice Address - Phone:203-735-7481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health