Healthcare Provider Details

I. General information

NPI: 1194713396
Provider Name (Legal Business Name): JUDY HARAN PH.D., M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5807 OAKLAND RD
SYKESVILLE MD
21784-6832
US

IV. Provider business mailing address

5807 OAKLAND RD
SYKESVILLE MD
21784-6832
US

V. Phone/Fax

Practice location:
  • Phone: 410-795-6161
  • Fax:
Mailing address:
  • Phone: 410-795-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-C 923
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: