MEDICARE: MRS. MEREDITH WHEELER HARRIS 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	4590	LA
2	1041C0700X	Clinical Social Worker	SW13128	FL

General Provider Information

NPI Number	:	1912008509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEREDITH WHEELER HARRIS LCSW

Provider Business Mailing Address
First Line	:	13670 METROPOLIS AVE
Second Line	:	101
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4346
Country	:	US
Telephone Number	:	504-615-7217
Fax Number	:	239-674-0304

Provider Business Practice Location Address
First Line	:	13670 METROPOLIS AVE
Second Line	:	101
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4346
Country	:	US
Telephone Number	:	504-615-7217
Fax Number	:	239-674-0304

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/09/2016

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