Provider Demographics
NPI:1396951174
Name:HARTMAN, BRENDA RAE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:RAE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117N 1ST ST 109
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1354
Mailing Address - Country:US
Mailing Address - Phone:734-332-4322
Mailing Address - Fax:
Practice Address - Street 1:117N 1ST ST 109
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1354
Practice Address - Country:US
Practice Address - Phone:734-332-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68-0-H1-4833-0OtherBCBS OF MI PIN