Provider Demographics
NPI:1891722013
Name:HARTMAN, BRENDA A (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:A
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 HAMLINE AVE N STE 204
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4226
Mailing Address - Country:US
Mailing Address - Phone:651-697-9981
Mailing Address - Fax:651-697-9982
Practice Address - Street 1:2151 HAMLINE AVE N STE 204
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4226
Practice Address - Country:US
Practice Address - Phone:651-697-9981
Practice Address - Fax:651-697-9982
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN81581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP21275OtherHEALTH PARTNERS
04D08HAOtherBLUE CROSS BLUE SHIELD