Healthcare Provider Details

I. General information

NPI: 1679607147
Provider Name (Legal Business Name): JOSEPH J HARPER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 CHURCH ST
NEW ATHENS IL
62264-1584
US

IV. Provider business mailing address

513 CHURCH ST
NEW ATHENS IL
62264-1584
US

V. Phone/Fax

Practice location:
  • Phone: 618-475-9202
  • Fax: 618-475-9214
Mailing address:
  • Phone: 618-475-9202
  • Fax: 618-475-9214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005905
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: