Provider Demographics
NPI:1669839759
Name:HARRIS-GRAY, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HARRIS-GRAY
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 1:2488 GRAND CONCRS
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5203
Mailing Address - Country:US
Mailing Address - Phone:718-584-7204
Mailing Address - Fax:718-584-8394
Practice Address - Street 1:2488 GRAND CONCRS
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5203
Practice Address - Country:US
Practice Address - Phone:718-584-7204
Practice Address - Fax:718-584-8394
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)