Healthcare Provider Details

I. General information

NPI: 1659823912
Provider Name (Legal Business Name): JEANNE HARTMAN, PH.D., PSYCHOLOGIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HILLSIDE AVE SUITE 99L
WILLISTON PARK NY
11596-2333
US

IV. Provider business mailing address

99 HILLSIDE AVE SUITE 99L
WILLISTON PARK NY
11596-2333
US

V. Phone/Fax

Practice location:
  • Phone: 516-294-4810
  • Fax: 516-294-4810
Mailing address:
  • Phone: 516-294-4810
  • Fax: 516-294-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number009351-1
License Number StateNY

VIII. Authorized Official

Name: DR. JEANNE HARTMAN
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 516-294-4810