Provider Demographics
NPI:1912415464
Name:HARTMAN, SARA WILSON
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:WILSON
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OAK RIDGE DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-2462
Mailing Address - Country:US
Mailing Address - Phone:978-897-2032
Mailing Address - Fax:
Practice Address - Street 1:3 OAK RIDGE DR UNIT 2
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-2462
Practice Address - Country:US
Practice Address - Phone:978-897-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1011851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical