MEDICARE: MS. STACY L HARRIS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	3212	KY
2	1041C0700X	Clinical Social Worker	3212	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457401374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACY L HARRIS LCSW

Provider Business Mailing Address
First Line	:	897 MOUNT RUSHMORE DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8760
Country	:	US
Telephone Number	:	859-951-4440
Fax Number	:	866-535-3105

Provider Business Practice Location Address
First Line	:	106 E MAIN ST
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-1647
Country	:	US
Telephone Number	:	606-776-4741
Fax Number	:	866-535-3105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	10/27/2020

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