Provider Demographics
NPI:1922882919
Name:HARRIS, JADA (LSW)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JADA
Other - Middle Name:
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:2677 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1570
Mailing Address - Country:US
Mailing Address - Phone:419-936-8375
Mailing Address - Fax:
Practice Address - Street 1:3030 EUCLID AVE STE 212
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2518
Practice Address - Country:US
Practice Address - Phone:216-302-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2208318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker