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General NPI Number Information
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NPI Number | 1730201203
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Entity Type | Individual
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Provider Name | JAMIE GRACE HARMON LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 17862 17TH ST STE 107
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City | TUSTIN
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State | CA
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Zip | 92780-2170
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Country | US
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Telephone | 949-812-8612
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Fax |
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Provider Business Mailing Address
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Address Line | 29 SKYWOOD ST
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City | LADERA RANCH
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State | CA
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Zip | 92694-0233
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 27460
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License Number State | CA
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