Provider Demographics
NPI:1962717447
Name:MELISSA HARTMANN, LCSW, LLC
Entity type:Organization
Organization Name:MELISSA HARTMANN, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-676-4731
Mailing Address - Street 1:38 ACADEMY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2611
Mailing Address - Country:US
Mailing Address - Phone:203-676-4731
Mailing Address - Fax:203-779-1013
Practice Address - Street 1:38 ACADEMY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2611
Practice Address - Country:US
Practice Address - Phone:203-676-4731
Practice Address - Fax:203-779-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004348251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health