Healthcare Provider Details

I. General information

NPI: 1750370045
Provider Name (Legal Business Name): JAMES W HARASYMIW PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W243S7630 EVERGREEN DR
MUKWONAGO WI
53149
US

IV. Provider business mailing address

W236S7050 BIG BEND DR STE 2
BIG BEND WI
53103-9497
US

V. Phone/Fax

Practice location:
  • Phone: 262-662-1116
  • Fax: 262-662-1118
Mailing address:
  • Phone: 262-662-1116
  • Fax: 262-662-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1625
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: