NPIMap

Individual provider Active NPI

Holly Harmon, LICSW

  • Clinical Social Worker
  • Andover, MA
National Provider Identifier
1760643274
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
116604 Issued in MA
Practice address
21 Central St Ste 28
Andover, MA 01810-3703
Phone
(978) 807-4637
Fax
(978) 446-1490
NPI assigned
Jun 18, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MA
Clinical Social Worker 1041C0700X 116604 MA Primary

Addresses

Primary practice location

21 Central St Ste 28
Andover, MA 01810-3703

Mailing address

21 Central St Ste 28
Andover, MA 01810-3703
Phone (978) 807-4637

Other practice location 1

203 Crescent St
Suite 110
Waltham, MA 02453-3436
Phone (781) 647-0066 ext. 14

Other practice location 2

203 Crescent St
Suite 110
Waltham, MA 02453-3436
Phone (781) 647-0066 ext. 14

Other identifiers 1

IdentifierTypeStateIssuer
1307606MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
116604MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Psychiatric Resources Past Accepting new patients
Crawford Hospital District Past Accepting new patients
Comprehensive Psychiatric Resources, Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1760643274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 CENTRAL ST STE 28",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103703",
            "telephone_number": "978-807-4637",
            "fax_number": "978-446-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 CENTRAL ST STE 28",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103703",
            "telephone_number": "978-807-4637",
            "fax_number": "978-446-1490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "203 Crescent St",
            "address_2": "Suite 110",
            "address_purpose": "LOCATION",
            "city": "Waltham",
            "state": "MA",
            "postal_code": "024533436",
            "country_code": "US",
            "telephone_number": "781-647-0066 x14",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "203 Crescent St",
            "address_2": "Suite 110",
            "address_purpose": "LOCATION",
            "city": "Waltham",
            "state": "MA",
            "postal_code": "024533436",
            "country_code": "US",
            "telephone_number": "781-647-0066 x14",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARMON",
        "first_name": "HOLLY",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-18",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "116604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1307606",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.