Provider Demographics
NPI:1396135158
Name:HARRIS, JOY
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:L
Other - Last Name:PENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9608 TUCKERMAN ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3431
Mailing Address - Country:US
Mailing Address - Phone:240-432-9556
Mailing Address - Fax:
Practice Address - Street 1:9608 TUCKERMAN ST
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3431
Practice Address - Country:US
Practice Address - Phone:240-432-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD47-2839907320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities