Provider Demographics
NPI:1619183803
Name:HARLAN, WILLIAM (MED, LMHC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HARLAN
Suffix:
Gender:M
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5610
Mailing Address - Country:US
Mailing Address - Phone:617-237-0473
Mailing Address - Fax:617-250-8880
Practice Address - Street 1:10 CONVERSE PL
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2713
Practice Address - Country:US
Practice Address - Phone:617-237-0473
Practice Address - Fax:617-250-8880
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2013-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health