Provider Demographics
NPI:1760479612
Name:HARTMAN-STEIN, PAULA E (PHD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:E
Last Name:HARTMAN-STEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 W MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2461
Mailing Address - Country:US
Mailing Address - Phone:330-678-9210
Mailing Address - Fax:330-676-1199
Practice Address - Street 1:265 W MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2461
Practice Address - Country:US
Practice Address - Phone:330-678-9210
Practice Address - Fax:330-676-1199
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3297103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341438143OtherTAX ID
OHR71164Medicare UPIN
OH9269241Medicare ID - Type UnspecifiedGROUP ID
OHCP02032Medicare ID - Type UnspecifiedINDIVIDUAL ID