Healthcare Provider Details

I. General information

NPI: 1396100079
Provider Name (Legal Business Name): BRIAN HACKMAN MSW, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 S BUTLER RD
LEBANON PA
17042-8939
US

IV. Provider business mailing address

785 5TH AVE STE 3
CHAMBERSBURG PA
17201-4232
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-8871
  • Fax: 717-270-2452
Mailing address:
  • Phone: 717-263-9555
  • Fax: 717-709-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC002446
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW131414
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: