Provider Demographics
NPI:1518192293
Name:HARRISON, JILL MONIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MONIQUE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:MONIQUE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 QUAKER CIR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1928
Mailing Address - Country:US
Mailing Address - Phone:781-400-4626
Mailing Address - Fax:
Practice Address - Street 1:1 BUMPS POND ROAD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-291-2441
Practice Address - Fax:508-291-2355
Is Sole Proprietor?:No
Enumeration Date:2009-05-25
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2692702084P0800X
GA651222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry