Provider Demographics
NPI:1649321258
Name:HARTMANN, RYAN D (PHD CLINICAL PSYCHO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:D
Last Name:HARTMANN
Suffix:
Gender:M
Credentials:PHD CLINICAL PSYCHO
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Mailing Address - Street 1:40 DALE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-676-9350
Mailing Address - Fax:860-678-7178
Practice Address - Street 1:40 DALE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-676-9350
Practice Address - Fax:860-678-7178
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY017197-1103TC0700X
IN20042132103TC0700X
CT002913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400002007Medicare PIN