MEDICARE: ELNORA AUSTIN HARRISON LMHC

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	101YM0800X	Mental Health Counselor	003811	NY

General Provider Information

NPI Number	:	1295888071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELNORA AUSTIN HARRISON LMHC

Provider Business Mailing Address
First Line	:	129-133 W 147TH ST
Second Line	:	APT. 26-J
City	:	NEW YORK
State	:	NY
Zip	:	10039-4303
Country	:	US
Telephone Number	:	212-690-2965
Fax Number	:	212-690-2965

Provider Business Practice Location Address
First Line	:	129-133 W 147TH ST
Second Line	:	APT. 26-J
City	:	NEW YORK
State	:	NY
Zip	:	10039-4303
Country	:	US
Telephone Number	:	212-690-2965
Fax Number	:	212-690-2965

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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