Provider Demographics
NPI:1518107168
Name:HARTMAN, CARRIE ANN (BCBA)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:ANN
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ORANGE ST
Mailing Address - Street 2:APT 43
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3800
Mailing Address - Country:US
Mailing Address - Phone:940-397-1973
Mailing Address - Fax:
Practice Address - Street 1:625 ORANGE ST
Practice Address - Street 2:APT 43
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3800
Practice Address - Country:US
Practice Address - Phone:940-397-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041545103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1041545OtherBCBA