Provider Demographics
NPI:1164644001
Name:HARTMAN, DIANE V (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:V
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:1202 MARKET ST
Mailing Address - City:HERMANN
Mailing Address - State:MO
Mailing Address - Zip Code:65041
Mailing Address - Country:US
Mailing Address - Phone:573-486-0136
Mailing Address - Fax:573-486-5042
Practice Address - Street 1:1202 MARKET ST.
Practice Address - Street 2:
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041
Practice Address - Country:US
Practice Address - Phone:573-486-0136
Practice Address - Fax:573-486-5042
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0047971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO168313OtherBLUE CROSS BLUE SHIELD MO