Provider Demographics
NPI:1487103099
Name:HARTMAN, LARA ELLEN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:ELLEN
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:640 LUCABAUGH MILL ROAD
Mailing Address - Street 2:ROOM A-1
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3814
Mailing Address - Country:US
Mailing Address - Phone:410-299-4261
Mailing Address - Fax:410-848-5629
Practice Address - Street 1:640 LUCABAUGH MILL ROAD
Practice Address - Street 2:ROOM A-1
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3814
Practice Address - Country:US
Practice Address - Phone:410-299-4261
Practice Address - Fax:410-848-5629
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7316101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional