Healthcare Provider Details

I. General information

NPI: 1114940749
Provider Name (Legal Business Name): JAY J HARTMAN MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 RIVER RD STE C1B
MONTVILLE NJ
07045-8953
US

IV. Provider business mailing address

150 RIVER RD STE C1B
MONTVILLE NJ
07045-8953
US

V. Phone/Fax

Practice location:
  • Phone: 973-257-0220
  • Fax: 973-588-7000
Mailing address:
  • Phone: 973-257-0220
  • Fax: 973-588-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05158600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: