MEDICARE: KIMBERLY ELIZABETH HARAN 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	016634	NY

General Provider Information

NPI Number	:	1396610465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ELIZABETH HARAN LMHC

Provider Business Mailing Address
First Line	:	111 FAIRVIEW RD
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-8129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 KNAPP ST STE 305
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1005
Country	:	US
Telephone Number	:	760-300-3664
Fax Number	:

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

Provider Enumeration Date	:	10/08/2025
Last Update Date	:	10/08/2025

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