Provider Demographics
NPI:1831407279
Name:HARSEVOORT, ELIZABETH R (LMSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:HARSEVOORT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:R
Other - Last Name:VAN FAROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 SETTLERS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3704
Mailing Address - Country:US
Mailing Address - Phone:616-796-9595
Mailing Address - Fax:616-796-9596
Practice Address - Street 1:355 SETTLERS RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3704
Practice Address - Country:US
Practice Address - Phone:616-796-9595
Practice Address - Fax:616-796-9596
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092545104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker