Provider Demographics
NPI:1104051671
Name:HARTMAN, JESSIE S (MSW)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:S
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DIAKON FAMILY LIFE SERVICES
Mailing Address - Street 2:1800 W. MARKET STREET
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837
Mailing Address - Country:US
Mailing Address - Phone:570-524-9477
Mailing Address - Fax:570-924-9492
Practice Address - Street 1:DIAKON FAMILY LIFE SERVICES
Practice Address - Street 2:435 W. FOURTH STREET
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701
Practice Address - Country:US
Practice Address - Phone:570-322-7873
Practice Address - Fax:570-322-8026
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007777400036Medicaid