Provider Demographics
NPI:1124462676
Name:HACKBARTH, ARLENE (MS)
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:
Last Name:HACKBARTH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W WEST ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3739
Mailing Address - Country:US
Mailing Address - Phone:410-752-4454
Mailing Address - Fax:410-752-4123
Practice Address - Street 1:203 BUTTONWOODS RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6571
Practice Address - Country:US
Practice Address - Phone:443-791-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional