Provider Demographics
NPI:1174659361
Name:HARTMAN, KELLY ANN VERBEKE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN VERBEKE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 MARLINSPIKE CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9329
Mailing Address - Country:US
Mailing Address - Phone:219-313-9442
Mailing Address - Fax:
Practice Address - Street 1:2037 MARLINSPIKE CT
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9329
Practice Address - Country:US
Practice Address - Phone:219-313-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004953A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical