Provider Demographics
NPI:1699247775
Name:HARTMAN, ANNELIESE (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:HURLEYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12747-5001
Mailing Address - Country:US
Mailing Address - Phone:845-705-7765
Mailing Address - Fax:
Practice Address - Street 1:109 ROSE LN
Practice Address - Street 2:
Practice Address - City:HURLEYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12747-5001
Practice Address - Country:US
Practice Address - Phone:845-705-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty