=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710104781
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARRY HARNICK MSW, LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6226 SAND HILLS CIR
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33463-8226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-945-4785
-----------------------------------------------------
Fax | 561-357-4779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6226 SAND HILLS CIR
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33463-8226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-945-4785
-----------------------------------------------------
Fax | 561-357-4779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW4122
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------