Individual
MR. SHANE WILLIAM HARTIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MDIV
Contact information
Practice address
551 W LANCASTER AVE, HAVERFORD, PA 19041-1419
(610) 526-1974
Mailing address
4336 TEESDALE ST, PHILADELPHIA, PA 19136-3903
(904) 302-2332
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
PA
Other
Enumeration date
09/24/2014
Last updated
09/24/2014
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