MEDICARE: JUDITH REBECCA HARTFIELD LMSW

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	M6907	MS

General Provider Information

NPI Number	:	1669805883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH REBECCA HARTFIELD LMSW

Provider Business Mailing Address
First Line	:	7 PROFESSIONAL PKWY STE 103
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-2648
Country	:	US
Telephone Number	:	601-264-4984
Fax Number	:	601-264-2648

Provider Business Practice Location Address
First Line	:	7 PROFESSIONAL PKWY STE 103
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-2648
Country	:	US
Telephone Number	:	601-264-4984
Fax Number	:	601-264-2648

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

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	08/12/2013

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