Provider Demographics
NPI:1508424151
Name:HARRIS, JASMINE CHRISTINA MONET
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:CHRISTINA MONET
Last Name:HARRIS
Suffix:
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:PO BOX 370141
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06137-0141
Mailing Address - Country:US
Mailing Address - Phone:860-573-3841
Mailing Address - Fax:
Practice Address - Street 1:98 CAYA AVE APT B2
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1114
Practice Address - Country:US
Practice Address - Phone:860-573-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028319614106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician