MEDICARE: KELLY HARPER LSW

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	104100000X	Social Worker	44SL06415100	NJ

General Provider Information

NPI Number	:	1881176469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY HARPER LSW

Provider Business Mailing Address
First Line	:	34 OVERLOOK DR
Second Line	:
City	:	DUMONT
State	:	NJ
Zip	:	07628-2017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 BLOOMFIELD AVE
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-2512
Country	:	US
Telephone Number	:	973-744-6522
Fax Number	:

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

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	08/30/2018

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