Provider Demographics
NPI:1932128311
Name:HARTWELL, NANCY ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELIZABETH
Last Name:HARTWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W 28TH ST
Mailing Address - Street 2:#9G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7920
Mailing Address - Country:US
Mailing Address - Phone:646-205-3238
Mailing Address - Fax:
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:646-205-3238
Practice Address - Fax:646-205-3238
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015021103G00000X
GAPSY002893103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL8681Medicare ID - Type Unspecified