MEDICARE: ELIZABETH HARTMAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C009407	NC

General Provider Information

NPI Number	:	1265898316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HARTMAN LCSW

Provider Business Mailing Address
First Line	:	16 BROOKWOOD AVE
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1108
Country	:	US
Telephone Number	:	917-558-3313
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 BROOKWOOD AVE
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1108
Country	:	US
Telephone Number	:	917-558-3313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	02/09/2016

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