Provider Demographics
NPI:1700960002
Name:HARMON, JILL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 N MAIN ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-1828
Mailing Address - Country:US
Mailing Address - Phone:845-292-4403
Mailing Address - Fax:
Practice Address - Street 1:59 N MAIN ST
Practice Address - Street 2:SUITE 330
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1828
Practice Address - Country:US
Practice Address - Phone:845-292-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0696981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical