Individual provider Active NPI

Jessica Emily Harrison, LCSW

  • Clinical Social Worker
  • Palm Beach Gardens, FL
National Provider Identifier
1801120480
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW5771 Issued in FL
Practice address
611 6TH Ter
Palm Beach Gardens, FL 33418-3605
Phone
(954) 600-6695
NPI assigned
Sep 29, 2009
Last updated
Nov 20, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW5771 FL Primary

Addresses

Primary practice location

611 6TH Ter
Palm Beach Gardens, FL 33418-3605

Mailing address

611 6TH Ter
Palm Beach Gardens, FL 33418-3605
Phone (954) 600-6695

Other practice location 1

400 N Pine Island Rd
Suite 200
Plantation, FL 33324-1868
Phone (954) 732-2888

Other identifiers 1

IdentifierTypeStateIssuer
003790900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120719000245 FL Practitioner - Clinical Social Worker 4082874094 Practice locations: Palm Beach Gardens, FL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

611 6TH Ter
Palm Beach Gardens, FL 33418-3605
Phone (954) 600-6695

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1801120480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 6TH TER",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334183605",
            "telephone_number": "954-600-6695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 6TH TER",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334183605",
            "telephone_number": "954-600-6695"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 N Pine Island Rd",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Plantation",
            "state": "FL",
            "postal_code": "333241868",
            "country_code": "US",
            "telephone_number": "954-732-2888",
            "fax_number": "954-749-3008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "JESSICA",
        "middle_name": "EMILY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-29",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW5771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003790900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Beach Gardens, FL

Sources for this page

Verify at the official NPI Registry.