Provider Demographics
NPI:1659662609
Name:HUMPHREY, HAROLD D (LCSW)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:D
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 SOUTH ORANGE BLOSSOM TRAIL
Mailing Address - Street 2:PO BOX 809
Mailing Address - City:INTERCESSION CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33848-0809
Mailing Address - Country:US
Mailing Address - Phone:407-846-5294
Mailing Address - Fax:407-846-5298
Practice Address - Street 1:5970 SOUTH ORANGE BLOSSOM TRAIL
Practice Address - Street 2:
Practice Address - City:INTERCESSION CITY
Practice Address - State:FL
Practice Address - Zip Code:33848-0809
Practice Address - Country:US
Practice Address - Phone:407-846-5294
Practice Address - Fax:407-846-5298
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW103311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical