Provider Demographics
NPI:1003555863
Name:HARTLEY, JENNIFER (LGSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SHUMILOFF LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-7805
Mailing Address - Country:US
Mailing Address - Phone:130-427-6608
Mailing Address - Fax:
Practice Address - Street 1:40 SHUMILOFF LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-7805
Practice Address - Country:US
Practice Address - Phone:130-427-6608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009439671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical