Basic Information
| Provider Information | |||||||||
| NPI: | 1437793585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARLAN | ||||||||
| FirstName: | PAIGE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 E BAY DR APT 151 | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337703740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522872850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 626 LAKEVIEW RD STE B | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274498331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2019 | ||||||||
| LastUpdateDate: | 11/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW15993 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.