Provider Demographics
NPI:1518974088
Name:HARTMAN, MICHAEL A (MSW, LCMHC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MSW, LCMHC
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 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-223-6328
Mailing Address - Fax:802-229-8004
Practice Address - Street 1:9 HEATON ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2489
Practice Address - Country:US
Practice Address - Phone:802-223-6328
Practice Address - Fax:802-229-8004
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00029847OtherBC/BS OF VT
VT1009572Medicaid
VT2078948OtherCIGNA
VT360323OtherTRICARE