MEDICARE: MS. MONICA A 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	R028206	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7494055	OTHER		GROUP HEALTH INS
2	P1071976	OTHER		OXFORD HEALTH PLANS

General Provider Information

NPI Number	:	1194881862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONICA A HARRIS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 716
Second Line	:
City	:	SOUTHAMPTON
State	:	NY
Zip	:	11969-0716
Country	:	US
Telephone Number	:	631-287-2813
Fax Number	:	631-287-2813

Provider Business Practice Location Address
First Line	:	134 SAINT ANDREWS CIRCLE
Second Line	:
City	:	SOUTHAMPTON
State	:	NY
Zip	:	11968-3818
Country	:	US
Telephone Number	:	631-287-2813
Fax Number	:

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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