Provider Demographics
NPI:1790749505
Name:HARAM, JOHN R (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:HARAM
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 GOSHEN LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-1324
Mailing Address - Country:US
Mailing Address - Phone:304-263-2220
Mailing Address - Fax:304-264-1531
Practice Address - Street 1:420 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2888
Practice Address - Country:US
Practice Address - Phone:304-263-2220
Practice Address - Fax:304-264-1531
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP004505591041C0700X
VAV003081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSP00381Medicare PIN