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General NPI Number Information
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NPI Number | 1912659525
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Entity Type | Individual
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Provider Name | JULISSA HARTMAN LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 220 FORBES RD
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City | BRAINTREE
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State | MA
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Zip | 02184-2705
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Country | US
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Telephone | 781-570-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 4990 LONGMIRE WAY
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City | CHANTILLY
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State | VA
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Zip | 20151-2557
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Country | US
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Telephone | 401-480-2412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 127493
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License Number State | MA
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