Provider Demographics
NPI:1922203314
Name:HARRIS, JANE L (JANE HARRIS)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:JANE HARRIS
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JANE HARRIS, LCSW
Mailing Address - Street 1:549 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-2007
Mailing Address - Country:US
Mailing Address - Phone:201-652-6755
Mailing Address - Fax:201-251-3185
Practice Address - Street 1:549 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-2007
Practice Address - Country:US
Practice Address - Phone:201-652-6755
Practice Address - Fax:201-251-3185
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00165500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ643382Medicare ID - Type Unspecified