MEDICARE: MS. VICTORIA ANN HARWOOD LCSW, CAP

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	1041C0700X	Clinical Social Worker	SW0002856	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U04762015	OTHER	FL	CIGNA PROVIDER #
2	070354	OTHER	FL	VALUE OPTIONS PROVIDER #
3	255651000	OTHER	FL	MBHC MIS#

General Provider Information

NPI Number	:	1902875008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICTORIA ANN HARWOOD LCSW, CAP

Provider Business Mailing Address
First Line	:	438 MYRTLEWOOD RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-7734
Country	:	US
Telephone Number	:	321-409-9191
Fax Number	:	321-409-9191

Provider Business Practice Location Address
First Line	:	1900 S HARBOR CITY BLVD
Second Line	:	STE 216
City	:	MELBOURNE
State	:	FL
Zip	:	32901-4749
Country	:	US
Telephone Number	:	321-409-9191
Fax Number	:	321-409-9191

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	09/27/2010

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