Healthcare Provider Details

I. General information

NPI: 1235264193
Provider Name (Legal Business Name): JANAN E HARTFORD MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6417 HURSTGREEN LN
AFFTON MO
63123-1504
US

IV. Provider business mailing address

6417 HURSTGREEN LN
AFFTON MO
63123-1504
US

V. Phone/Fax

Practice location:
  • Phone: 314-963-4605
  • Fax:
Mailing address:
  • Phone: 314-963-4605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW001681
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: