Healthcare Provider Details

I. General information

NPI: 1497820401
Provider Name (Legal Business Name): STEVEN LEE HARTSOCK PH.D., MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 BALTIMORE ST STE 212
CUMBERLAND MD
21502-3065
US

IV. Provider business mailing address

PO BOX 1493
CUMBERLAND MD
21501-1493
US

V. Phone/Fax

Practice location:
  • Phone: 301-777-9005
  • Fax: 301-777-3022
Mailing address:
  • Phone: 301-777-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05121
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier439831900
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: