MEDICARE: MRS. LISA FERN HARRISON MSW

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

General Provider Information

NPI Number	:	1477714558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA FERN HARRISON MSW

Provider Business Mailing Address
First Line	:	4041 AMETHYST DR
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-8084
Country	:	US
Telephone Number	:	765-807-5379
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 FARABEE DR N
Second Line	:	SUITE C
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-5913
Country	:	US
Telephone Number	:	765-423-5600
Fax Number	:

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	06/20/2008

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