Provider Demographics
NPI:1750370045
Name:HARASYMIW, JAMES W (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:HARASYMIW
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W236S7050 BIG BEND DR
Mailing Address - Street 2:STE 2
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103-9497
Mailing Address - Country:US
Mailing Address - Phone:262-662-1116
Mailing Address - Fax:262-662-1118
Practice Address - Street 1:W243S7630 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149
Practice Address - Country:US
Practice Address - Phone:262-662-1116
Practice Address - Fax:262-662-1118
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1625103T00000X
103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39192500Medicaid
R60511Medicare UPIN
WI443500001Medicare ID - Type Unspecified