Provider Demographics
NPI:1659623197
Name:HARTKE, GRAHAM JEFFREY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:JEFFREY
Last Name:HARTKE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1324
Mailing Address - Country:US
Mailing Address - Phone:973-885-6315
Mailing Address - Fax:973-251-9461
Practice Address - Street 1:104 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1324
Practice Address - Country:US
Practice Address - Phone:973-885-6315
Practice Address - Fax:973-251-9461
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5014103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist