Provider Demographics
NPI:1992884985
Name:HARWOOD, JENNIFER L (LCSW,LCAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HARWOOD
Suffix:
Gender:F
Credentials:LCSW,LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WEINBACH AVE STE 730
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-5977
Mailing Address - Country:US
Mailing Address - Phone:812-470-3640
Mailing Address - Fax:888-852-3390
Practice Address - Street 1:600 N WEINBACH AVE STE 730
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711
Practice Address - Country:US
Practice Address - Phone:812-470-3640
Practice Address - Fax:888-852-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004890A1041C0700X, 1041C0700X
KY1855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN89000999AOtherLICENSED CLINICAL ADDICTIONS COUNSELOR
IN34004890AOtherLICENSED CLINICAL SOCIAL WORKER
IN34004890AOtherLICENSED CLINICAL SOCIAL WORKER
KY1855OtherSTATE LICENSE NUMBER