Healthcare Provider Details

I. General information

NPI: 1144347485
Provider Name (Legal Business Name): JOHN STUART HARTLINE L.M.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 BROOKTREE RD STE 207
WEXFORD PA
15090
US

IV. Provider business mailing address

9500 BROOKTREE RD STE 207
WEXFORD PA
15090-9227
US

V. Phone/Fax

Practice location:
  • Phone: 412-605-4697
  • Fax:
Mailing address:
  • Phone: 412-605-4697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016070
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3022440
Identifier TypeMEDICAID
Identifier StateMI
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: