Healthcare Provider Details

I. General information

NPI: 1750741468
Provider Name (Legal Business Name): EDIE HARTWICK MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 3RD ST FL 2
SAN FRANCISCO CA
94103-3103
US

IV. Provider business mailing address

PO BOX 2182
GLENDORA CA
91740-2182
US

V. Phone/Fax

Practice location:
  • Phone: 833-483-3838
  • Fax:
Mailing address:
  • Phone: 626-885-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT150965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: