Provider Demographics
NPI:1972718625
Name:GEORGES HARTMAN, ANGELA MARIE (LCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:GEORGES HARTMAN
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:GEORGES HARTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LCAC
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-621-7584
Mailing Address - Fax:317-957-2705
Practice Address - Street 1:1011 MAIN ST
Practice Address - Street 2:STE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-6970
Practice Address - Country:US
Practice Address - Phone:317-957-9050
Practice Address - Fax:317-957-9952
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001568A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000767918OtherBCBS
INP01424408OtherRAIL ROAD PTAN
IN266180442Medicare PIN
INP01424408OtherRAIL ROAD PTAN