=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346667896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLLY HARMON, LICSW, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2014
-----------------------------------------------------
Last Update Date | 03/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 TURNPIKE ST SUITE 300
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-6156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-807-4637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 TURNPIKE ST SUITE 300
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-6156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-807-4637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HOLLY HARMON
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 978-807-4637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 116604
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------