=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336911569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN D HARRYMAN ACSW, M ED., MFA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2023
-----------------------------------------------------
Last Update Date | 08/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23701 E. FORK RD
-----------------------------------------------------
City | AZUSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91702-9003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-910-1202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23701 E. FORK RD
-----------------------------------------------------
City | AZUSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91702-1477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-209-7487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ASW122872
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------