Provider Demographics
NPI:1851624118
Name:HARTMAN, ROBERTA MALLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:MALLER
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROBERTA
Other - Middle Name:G
Other - Last Name:MALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:315 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4309
Mailing Address - Country:US
Mailing Address - Phone:847-831-5660
Mailing Address - Fax:847-831-5660
Practice Address - Street 1:315 BRIAR LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4309
Practice Address - Country:US
Practice Address - Phone:847-831-5660
Practice Address - Fax:847-831-5660
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004042103TC0700X
103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth