Provider Demographics
NPI:1487649380
Name:HARTMAN, HENRY BOB (PHD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:BOB
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OLD MAMARONECK RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2010
Mailing Address - Country:US
Mailing Address - Phone:914-761-6868
Mailing Address - Fax:914-761-7213
Practice Address - Street 1:12 OLD MAMARONECK RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2010
Practice Address - Country:US
Practice Address - Phone:914-761-6868
Practice Address - Fax:914-761-7213
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00538505Medicaid
NY00538505Medicaid