Provider Demographics
NPI:1538842273
Name:HARTLEY, JENNIFER (MED; LBS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:MED; LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OLIVER RD STE 116
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-2376
Mailing Address - Country:US
Mailing Address - Phone:724-747-5865
Mailing Address - Fax:
Practice Address - Street 1:8 OLIVER RD STE 116
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2376
Practice Address - Country:US
Practice Address - Phone:724-747-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PABH000978103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
5874OtherHEALTH PARTNERS
DC236Medicaid
568946544OtherBCBS