Provider Demographics
NPI:1730292764
Name:HARTMAN, VERONICA E (LCSW)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:E
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:ME
Mailing Address - Zip Code:04048-3211
Mailing Address - Country:US
Mailing Address - Phone:207-423-2573
Mailing Address - Fax:207-282-7509
Practice Address - Street 1:4 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:ME
Practice Address - Zip Code:04048-3211
Practice Address - Country:US
Practice Address - Phone:207-423-2573
Practice Address - Fax:207-282-7509
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC111001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME414900099Medicaid