Provider Demographics
NPI:1144048497
Name:HARTMAN, JANELLE AGNES (LCSW-R)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:AGNES
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 29TH ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2890
Mailing Address - Country:US
Mailing Address - Phone:917-545-0162
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST # A6-9
Practice Address - Street 2:
Practice Address - City:ROOSEVELT ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10044-0066
Practice Address - Country:US
Practice Address - Phone:212-848-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0431221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical