MEDICARE: TAYLO MARIAH HARRISON LCSW

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	0904016373	VA

General Provider Information

NPI Number	:	1750051447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLO MARIAH HARRISON LCSW

Provider Business Mailing Address
First Line	:	7741 BRINK RD
Second Line	:
City	:	EMPORIA
State	:	VA
Zip	:	23847-5311
Country	:	US
Telephone Number	:	434-632-1697
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 BROAD ROCK BLVD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23249-0001
Country	:	US
Telephone Number	:	804-675-5000
Fax Number	:

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

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	01/06/2026

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