MEDICARE: LYNDSIE HELENE HARRIS ASW

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	ASW132251	CA

General Provider Information

NPI Number	:	1114759305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDSIE HELENE HARRIS ASW

Provider Business Mailing Address
First Line	:	PO BOX 231523
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-0408
Country	:	US
Telephone Number	:	916-524-9372
Fax Number	:

Provider Business Practice Location Address
First Line	:	9412 BIG HORN BLVD STE 6
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-1101
Country	:	US
Telephone Number	:	916-710-5874
Fax Number	:

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

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	02/11/2026

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