Provider Demographics
NPI:1386855583
Name:HARMON, THERESA MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:HARMON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 RUSSELL MILLS RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3018
Mailing Address - Country:US
Mailing Address - Phone:941-391-0746
Mailing Address - Fax:
Practice Address - Street 1:6 MAIN STREET EXT STE 615
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3366
Practice Address - Country:US
Practice Address - Phone:941-391-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1161161041C0700X
MAAPRN10005249363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768265400Medicaid