1619183803 NPI number — WILLIAM HARLAN MED, LMHC

Table of content: WILLIAM HARLAN MED, LMHC (NPI 1619183803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619183803 NPI number — WILLIAM HARLAN MED, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARLAN
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MED, LMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619183803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 HANCOCK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02155-5610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-237-0473
Provider Business Mailing Address Fax Number:
617-250-8880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 CONVERSE PL
Provider Second Line Business Practice Location Address:
THIRD FLOOR
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01890-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-237-0473
Provider Business Practice Location Address Fax Number:
617-250-8880
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  7065 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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