Active NPI
Jacquelyn Harris
- Mental Health Counselor
- Port Jefferson, NY
National Provider Identifier
1285502500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 129069
- Practice address
- 118 Spring St
Port Jefferson, NY 11777-1817 - Phone
- (631) 476-0564
- NPI assigned
- Oct 28, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 129069 | NY | Primary |
Addresses
Primary practice location
118 Spring St
Port Jefferson, NY 11777-1817
Mailing address
118 Spring St
Port Jefferson, NY 11777-1817
Phone (631) 476-0564
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 129069 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761609600000",
"number": "1285502500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 SPRING ST",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771817",
"telephone_number": "631-476-0564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 SPRING ST",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117771817",
"telephone_number": "631-476-0564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "JACQUELYN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-10-28",
"last_updated": "2025-10-28",
"certification_date": "2025-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "129069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.