MEDICARE: ROSALYN YAVETTE HARRIS LMSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1225183775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN YAVETTE HARRIS LMSW

Provider Business Mailing Address
First Line	:	PO BOX 835066
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75083-5066
Country	:	US
Telephone Number	:	972-490-9055
Fax Number	:	972-490-9058

Provider Business Practice Location Address
First Line	:	7667 ROUNDROCK RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-5335
Country	:	US
Telephone Number	:	972-490-9055
Fax Number	:	972-490-9058

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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