MEDICARE: NICOLE HARRIS MA, NCC

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	NONE
2	101YM0800X	Mental Health Counselor	010873	NY

General Provider Information

NPI Number	:	1508351081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE HARRIS MA, NCC

Provider Business Mailing Address
First Line	:	800 SAINT ANNS AVE APT 9C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-7881
Country	:	US
Telephone Number	:	732-978-0031
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 SAINT ANNS AVE APT 9C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-7881
Country	:	US
Telephone Number	:	732-978-0031
Fax Number	:

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

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	05/19/2023

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