Provider Demographics
NPI:1154103794
Name:HARMON, TIM (LCSW, LADC)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:HARMON
Suffix:
Gender:M
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 AUTUMN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1258
Mailing Address - Country:US
Mailing Address - Phone:203-298-8042
Mailing Address - Fax:
Practice Address - Street 1:50 AUTUMN RIDGE RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1258
Practice Address - Country:US
Practice Address - Phone:203-298-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1369101YA0400X
CT123321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)