Provider Demographics
NPI:1124622014
Name:HARRISON, JESSICA ANN (LCSW-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5062 JUDICIAL WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-4807
Mailing Address - Country:US
Mailing Address - Phone:908-227-8864
Mailing Address - Fax:667-600-4038
Practice Address - Street 1:2700 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-3115
Practice Address - Country:US
Practice Address - Phone:667-600-3984
Practice Address - Fax:667-600-4065
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD219611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical