Provider Demographics
NPI:1336911569
Name:HARRYMAN, KAREN D (ACSW, M ED, MFA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:HARRYMAN
Suffix:
Gender:F
Credentials:ACSW, M ED, MFA
Other - Prefix:
Other - First Name:K.D.
Other - Middle Name:
Other - Last Name:HARRYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACSW, M ED, MFA
Mailing Address - Street 1:23701 E. FORK RD
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1477
Mailing Address - Country:US
Mailing Address - Phone:818-209-7487
Mailing Address - Fax:
Practice Address - Street 1:23701 E. FORK RD
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-9003
Practice Address - Country:US
Practice Address - Phone:626-910-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1228721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical