Provider Demographics
NPI:1417203969
Name:HARRIS, JENNIFER DEBBIE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DEBBIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4807
Mailing Address - Country:US
Mailing Address - Phone:718-769-4265
Mailing Address - Fax:
Practice Address - Street 1:2625 E 14TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3979
Practice Address - Country:US
Practice Address - Phone:719-769-2698
Practice Address - Fax:718-943-7035
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7999162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist