Provider Demographics
NPI:1467589093
Name:HARDER, JOHN D (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:HARDER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N. MAIN ST.
Mailing Address - Street 2:SUITE 335
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-6060
Mailing Address - Country:US
Mailing Address - Phone:719-582-1462
Mailing Address - Fax:719-296-8322
Practice Address - Street 1:720 N MAIN ST
Practice Address - Street 2:SUITE 335
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3020
Practice Address - Country:US
Practice Address - Phone:719-582-1462
Practice Address - Fax:719-296-8322
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9924741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO645292OtherBLUE CROSS BLUE SHIELD
CO152017Medicaid
COC3916Medicare ID - Type Unspecified
CO645292OtherBLUE CROSS BLUE SHIELD