Provider Demographics
NPI:1962413054
Name:HARTMANN, CRAIG R (PHD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:HARTMANN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 FREEPORT RD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3103
Mailing Address - Country:US
Mailing Address - Phone:412-963-2320
Mailing Address - Fax:412-963-2318
Practice Address - Street 1:211 N WHITFIELD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3039
Practice Address - Country:US
Practice Address - Phone:412-963-2320
Practice Address - Fax:412-963-2318
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008720L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01809416Medicaid
PA01809416Medicaid