Provider Demographics
NPI:1619098001
Name:HARLOW, JASEN WHALEN (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JASEN
Middle Name:WHALEN
Last Name:HARLOW
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:L
Other - Last Name:BOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:15 STORY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4950
Mailing Address - Country:US
Mailing Address - Phone:617-702-2134
Mailing Address - Fax:617-643-7667
Practice Address - Street 1:15 STORY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4950
Practice Address - Country:US
Practice Address - Phone:617-702-2134
Practice Address - Fax:617-643-7667
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1157501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical