| Grace E. Hazeltine Bartman, Ph.d., Psychologist | |
|
4212 1/2 Overland Ave Culver City CA 90230-3736 | |
| (323) 553-2205 | |
| Not Available |
| Full Name | Grace E. Hazeltine Bartman, Ph.d., Psychologist |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4212 1/2 Overland Ave, Culver City, California |
| Authorized Official Name and Position | Grace E Hazeltine (OWNER) |
| Authorized Official Contact | 3235532205 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace E. Hazeltine Bartman, Ph.d., Psychologist 4212 1/2 Overland Ave Culver City CA 90230-3736 Ph: () - | Grace E. Hazeltine Bartman, Ph.d., Psychologist 4212 1/2 Overland Ave Culver City CA 90230-3736 Ph: (323) 553-2205 |
| NPI Number | 1760197255 |
|---|---|
| Provider Enumeration Date | 01/18/2023 |
| Last Update Date | 01/18/2023 |
| Certification Date | 01/18/2023 |
| Medicare PECOS PAC ID | 7416320379 |
|---|---|
| Medicare Enrollment ID | O20230224000793 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760197255 | NPI | - | NPPES |
| 1578008256 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Grace E Hazeltine |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578008256 PECOS PAC ID: 8325411283 Enrollment ID: I20230301002177 |
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