MEDICARE: MS. HOLLY AYN HARRY M.S.W.

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	004004	CT
2	1041C0700X	Clinical Social Worker	SW11872	FL

General Provider Information

NPI Number	:	1265587646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY AYN HARRY M.S.W.

Provider Business Mailing Address
First Line	:	400 VILLAGE SQUARE XING
Second Line	:	SUITE 2A
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3227
Country	:	US
Telephone Number	:	203-815-5001
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 VILLAGE SQUARE XING
Second Line	:	SUITE 2A
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3227
Country	:	US
Telephone Number	:	203-815-5001
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	06/17/2015

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