Provider Demographics
NPI:1356679872
Name:HARRISON, JENNIFER L (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01061-0441
Mailing Address - Country:US
Mailing Address - Phone:413-341-5912
Mailing Address - Fax:
Practice Address - Street 1:49 GOTHIC ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3047
Practice Address - Country:US
Practice Address - Phone:413-341-5912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1356679872Medicare UPIN