MEDICARE: DR. JAMES W HARASYMIW PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1625	WI
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750370045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES W HARASYMIW PSYD

Provider Business Mailing Address
First Line	:	W236S7050 BIG BEND DR
Second Line	:	STE 2
City	:	BIG BEND
State	:	WI
Zip	:	53103-9497
Country	:	US
Telephone Number	:	262-662-1116
Fax Number	:	262-662-1118

Provider Business Practice Location Address
First Line	:	W243S7630 EVERGREEN DR
Second Line	:
City	:	MUKWONAGO
State	:	WI
Zip	:	53149
Country	:	US
Telephone Number	:	262-662-1116
Fax Number	:	262-662-1118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	04/07/2011

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