Provider Demographics
NPI:1063542819
Name:HARWOOD, JUDITH FAYE (LICSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:FAYE
Last Name:HARWOOD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PORTER CIR
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2106
Mailing Address - Country:US
Mailing Address - Phone:617-497-1477
Mailing Address - Fax:
Practice Address - Street 1:1 PORTER CIR
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2106
Practice Address - Country:US
Practice Address - Phone:617-497-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1859421Medicaid
MA1859421Medicaid