Healthcare Provider Details

I. General information

NPI: 1487103099
Provider Name (Legal Business Name): LARA ELLEN HARTMAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 LUCABAUGH MILL ROAD ROOM A-1
WESTMINSTER MD
21157-3814
US

IV. Provider business mailing address

640 LUCABAUGH MILL ROAD ROOM A-1
WESTMINSTER MD
21157-3814
US

V. Phone/Fax

Practice location:
  • Phone: 410-299-4261
  • Fax: 410-848-5629
Mailing address:
  • Phone: 410-299-4261
  • Fax: 410-848-5629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC7316
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: