Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071004042 | IL |
Y | 103TC0700X | Clinical Psychologist | 071004042 | IL |
N | 103TH0004X | Health Psychologist |
NPI | 1851624118 |
---|---|
Provider Name | Dr. Roberta Maller Hartman |
First Address | Highland Park, IL 60035-4309 |
Second Address | Highland Park, IL 60035-4309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2009 |
Last Update Date | 17/09/2009 |