Healthcare Provider Details

I. General information

NPI: 1386748820
Provider Name (Legal Business Name): KATHLEEN ANNE HARTMAN-MCCARTHY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E CLINTON TRL
CHARLOTTE MI
48813-9334
US

IV. Provider business mailing address

1616 E CLINTON TRL
CHARLOTTE MI
48813-9334
US

V. Phone/Fax

Practice location:
  • Phone: 219-242-4862
  • Fax: 219-529-6297
Mailing address:
  • Phone: 219-242-4862
  • Fax: 219-529-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004490A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114278
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: