Healthcare Provider Details

I. General information

NPI: 1306887401
Provider Name (Legal Business Name): JONATHAN HOMER HARMON BS, RSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32841 AUGUSTA CT
ROMULUS MI
48174-6300
US

IV. Provider business mailing address

32841 AUGUSTA CT
ROMULUS MI
48174-6300
US

V. Phone/Fax

Practice location:
  • Phone: 313-516-5554
  • Fax:
Mailing address:
  • Phone: 313-516-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number720509
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: