Provider Demographics
NPI:1518990951
Name:HARNESS, SUSAN H (LMSW;ACSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:H
Last Name:HARNESS
Suffix:
Gender:F
Credentials:LMSW;ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 HARBEN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-4904
Mailing Address - Country:US
Mailing Address - Phone:517-784-2627
Mailing Address - Fax:517-784-2627
Practice Address - Street 1:3346 HARBEN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-4904
Practice Address - Country:US
Practice Address - Phone:517-784-2627
Practice Address - Fax:517-784-2627
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010641911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical