MEDICARE: MS. KATHY D 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	1041C0700X	Clinical Social Worker	046938	NY

General Provider Information

NPI Number	:	1013287796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY D HARRIS LCSW

Provider Business Mailing Address
First Line	:	154 SICKLES AVE
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10801-3806
Country	:	US
Telephone Number	:	914-632-2792
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 E 147TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4104
Country	:	US
Telephone Number	:	646-393-9680
Fax Number	:

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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