Provider Demographics
NPI:1386453207
Name:HARWOOD, SAM
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:HARWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:KITTREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80457-0152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 152
Practice Address - Street 2:
Practice Address - City:KITTREDGE
Practice Address - State:CO
Practice Address - Zip Code:80457-0152
Practice Address - Country:US
Practice Address - Phone:630-915-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099271871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical