Provider Demographics
NPI:1033138573
Name:HART, BRIAN C (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:HART
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-1832
Mailing Address - Country:US
Mailing Address - Phone:607-625-5407
Mailing Address - Fax:607-625-5407
Practice Address - Street 1:158 FOREST HILL RD
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-1832
Practice Address - Country:US
Practice Address - Phone:607-625-5407
Practice Address - Fax:607-625-5407
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042704-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53987BMedicare ID - Type Unspecified