Provider Demographics
NPI:1316336779
Name:HARLAN, DENISE KAREN
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:KAREN
Last Name:HARLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:KAREN
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:547 BETHANY CURV
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5312
Mailing Address - Country:US
Mailing Address - Phone:831-247-7740
Mailing Address - Fax:
Practice Address - Street 1:251 LLEWELLYN AVE BLDG C
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1940
Practice Address - Country:US
Practice Address - Phone:408-628-5592
Practice Address - Fax:408-874-7151
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA867541041C0700X
CAASW647321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical