MEDICARE: MONICA LEE HARDY PEER SUPPORTER

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	175T00000X	Peer Specialist	APS.003368	OH
2	101YM0800X	Mental Health Counselor	APS.003368	OH

General Provider Information

NPI Number	:	1255066148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA LEE HARDY PEER SUPPORTER

Provider Business Mailing Address
First Line	:	2020 TAYLOR RD APT 818
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-2945
Country	:	US
Telephone Number	:	216-309-3090
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 TAYLOR RD APT 818
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-2945
Country	:	US
Telephone Number	:	216-309-3090
Fax Number	:

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

Provider Enumeration Date	:	07/23/2022
Last Update Date	:	07/23/2022

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