Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0904007361 | VA |
NPI | 1003125030 |
---|---|
Provider Name | Jennifer Hartman |
First Address | Sandston, VA 23150 |
Second Address | Colonial Heights, VA 23834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2010 |
Last Update Date | 24/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0904007361 | DEPARTMENT OF HEALTH PROFESSIONS - BOARD OF SOCIAL WORK (01) | VA |