MEDICARE: JULISSA HARTMAN LICSW

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	127493	MA

General Provider Information

NPI Number	:	1912659525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULISSA HARTMAN LICSW

Provider Business Mailing Address
First Line	:	4990 LONGMIRE WAY
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20151-2557
Country	:	US
Telephone Number	:	401-480-2412
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 FORBES RD
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-2705
Country	:	US
Telephone Number	:	781-570-3530
Fax Number	:

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

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	01/30/2025

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