Provider Demographics
NPI:1215685581
Name:HARRIS, JODI D (CASAC-T)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:D
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 BROADWAY ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-1460
Mailing Address - Country:US
Mailing Address - Phone:716-886-1247
Mailing Address - Fax:
Practice Address - Street 1:1021 BROADWAY ST FL 5
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1460
Practice Address - Country:US
Practice Address - Phone:716-886-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist