Provider Demographics
NPI:1548365422
Name:HARTIENS, JONATHAN M (PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:HARTIENS
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 1:94 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9284
Mailing Address - Country:US
Mailing Address - Phone:304-260-8808
Mailing Address - Fax:304-263-8763
Practice Address - Street 1:94 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9284
Practice Address - Country:US
Practice Address - Phone:304-260-8808
Practice Address - Fax:304-263-8763
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV928103TC0700X
VA0810000219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical