Healthcare Provider Details

I. General information

NPI: 1811003825
Provider Name (Legal Business Name): ELLEN JEANNE HARMANSKY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 MAIN ST FL 2
OSTERVILLE MA
02655-2048
US

IV. Provider business mailing address

832 MAIN ST FL 2
OSTERVILLE MA
02655-2048
US

V. Phone/Fax

Practice location:
  • Phone: 508-420-4480
  • Fax: 508-420-4480
Mailing address:
  • Phone: 508-420-4480
  • Fax: 508-420-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1020727
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: