MEDICARE: MR. LOUIS R HARSON 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	R026357-1	NY

General Provider Information

NPI Number	:	1235116245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOUIS R HARSON LCSW

Provider Business Mailing Address
First Line	:	2901 202ND ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11360-2328
Country	:	US
Telephone Number	:	718-631-8740
Fax Number	:	718-631-8740

Provider Business Practice Location Address
First Line	:	2391 BELL BLVD
Second Line	:	STE 202 BAYSIDE MEDICAL ARTS CENTER
City	:	BAYSIDE
State	:	NY
Zip	:	11360-2019
Country	:	US
Telephone Number	:	718-631-8740
Fax Number	:	718-631-8740

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/08/2007

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