Provider Demographics
NPI:1386855583
Name:HARMON, THERESA MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:HARMON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ALDEN TER
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4518
Mailing Address - Country:US
Mailing Address - Phone:941-391-0746
Mailing Address - Fax:
Practice Address - Street 1:16 ALDEN TER
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4518
Practice Address - Country:US
Practice Address - Phone:941-391-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1161161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768265400Medicaid