Provider Demographics
NPI:1184453565
Name:HARRIS, JEFFERY (LEAD INSPECTOR)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LEAD INSPECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4342
Mailing Address - Country:US
Mailing Address - Phone:508-543-1109
Mailing Address - Fax:
Practice Address - Street 1:3 CAPITOL HL STE 206
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5034
Practice Address - Country:US
Practice Address - Phone:401-222-7751
Practice Address - Fax:401-222-2456
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILI00096171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty