MEDICARE: TIDEWATER MUSIC THERAPY

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	225A00000X	Music Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316804339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIDEWATER MUSIC THERAPY

Provider Business Mailing Address
First Line	:	4030 GEORGE WASHINGTON MEM HWY STE C
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-2619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4030 GEORGE WASHINGTON MEM HWY STE C
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-2619
Country	:	US
Telephone Number	:	757-255-8866
Fax Number	:

Authorized Official
Title or Position	:	MUSIC THERAPIST
Name	:	NICOLE HARNEY
Credential	:	MT-BC
Telephone Number	:	757-255-8866

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	02/06/2026

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Directions to “TIDEWATER MUSIC THERAPY ” Practice Location

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