Provider Demographics
NPI:1427538479
Name:HARBECK, ERIC JR
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:HARBECK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MASCOMA ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2647
Mailing Address - Country:US
Mailing Address - Phone:603-448-4872
Mailing Address - Fax:603-727-9353
Practice Address - Street 1:141 MASCOMA ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2647
Practice Address - Country:US
Practice Address - Phone:603-448-4872
Practice Address - Fax:603-727-9353
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 171M00000X
NH28331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077550Medicaid