Provider Demographics
NPI:1770839748
Name:CLARK-HARRIS, JENNIFER ALISON (MS, MED)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ALISON
Last Name:CLARK-HARRIS
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ALISON
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MED, LMHC/MFT
Mailing Address - Street 1:120 MAPLE ST STE 304
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2216
Mailing Address - Country:US
Mailing Address - Phone:413-377-6400
Mailing Address - Fax:
Practice Address - Street 1:120 MAPLE ST STE 304
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2216
Practice Address - Country:US
Practice Address - Phone:413-377-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X, 106H00000X
MALMHC10000618101YA0400X, 101YM0800X
101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health