Provider Demographics
NPI:1619338399
Name:HARRIS, INEZ J (BPS)
Entity Type:Individual
Prefix:
First Name:INEZ
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5749 WESTGATE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5040
Mailing Address - Country:US
Mailing Address - Phone:407-697-5169
Mailing Address - Fax:186-669-3681
Practice Address - Street 1:1221 W COLONIAL DR STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7164
Practice Address - Country:US
Practice Address - Phone:321-800-4488
Practice Address - Fax:321-800-4499
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL231390618Medicaid