Provider Demographics
NPI:1710754338
Name:HARTMAN, GABRIEL DAVID CHARLES
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:DAVID CHARLES
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19806 AURORA AVE N OFC
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3524
Mailing Address - Country:US
Mailing Address - Phone:206-702-1155
Mailing Address - Fax:
Practice Address - Street 1:19806 AURORA AVE N OFC
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3524
Practice Address - Country:US
Practice Address - Phone:206-702-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 1041C0700X
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist