Provider Demographics
NPI:1760197255
Name:GRACE E. HAZELTINE BARTMAN, PH.D., PSYCHOLOGIST
Entity Type:Organization
Organization Name:GRACE E. HAZELTINE BARTMAN, PH.D., PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAZELTINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-553-2205
Mailing Address - Street 1:4212 1/2 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-3736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4212 1/2 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-3736
Practice Address - Country:US
Practice Address - Phone:323-553-2205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578008256OtherNPI