Provider Demographics
NPI:1669805883
Name:HARTFIELD, JUDITH REBECCA (LMSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:REBECCA
Last Name:HARTFIELD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PROFESSIONAL PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2648
Mailing Address - Country:US
Mailing Address - Phone:601-264-4984
Mailing Address - Fax:601-264-2648
Practice Address - Street 1:7 PROFESSIONAL PKWY STE 103
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2648
Practice Address - Country:US
Practice Address - Phone:601-264-4984
Practice Address - Fax:601-264-2648
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM69071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical