Provider Demographics
NPI:1346805140
Name:JENNIFER M HARRIS PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:JENNIFER M HARRIS PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORK/PSYCHOTHERAPY
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:617-515-5885
Mailing Address - Street 1:52 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6210
Mailing Address - Country:US
Mailing Address - Phone:617-383-4036
Mailing Address - Fax:
Practice Address - Street 1:52 GRAY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-6210
Practice Address - Country:US
Practice Address - Phone:617-383-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health