Healthcare Provider Details

I. General information

NPI: 1972339646
Provider Name (Legal Business Name): JESSICA HARMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MAIN ST
BEACON NY
12508-2770
US

IV. Provider business mailing address

800 WOLCOTT AVE APT A
BEACON NY
12508-4260
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-2703
  • Fax: 845-838-4915
Mailing address:
  • Phone: 785-580-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124502
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: