MEDICARE: TERICA HARVEY MSW

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	ISW12533	FL

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

General Provider Information

NPI Number	:	1639721335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERICA HARVEY MSW

Provider Business Mailing Address
First Line	:	4855 TOWN CENTER PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-8437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N WEST SHORE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1917
Country	:	US
Telephone Number	:	813-282-9910
Fax Number	:

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

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	07/12/2019

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