Healthcare Provider Details

I. General information

NPI: 1629470117
Provider Name (Legal Business Name): DEBORAH HARTMAN CATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4283 EL CAJON BLVD SUITE 115
SAN DIEGO CA
92105-1289
US

IV. Provider business mailing address

4283 EL CAJON BLVD SUITE 115
SAN DIEGO CA
92105-1289
US

V. Phone/Fax

Practice location:
  • Phone: 619-521-1743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number051138II
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA9090613
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: