Provider Demographics
NPI:1063449098
Name:HART, CAROL L (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:HART
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03276-0029
Mailing Address - Country:US
Mailing Address - Phone:603-286-4159
Mailing Address - Fax:
Practice Address - Street 1:291 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:TILTON
Practice Address - State:NH
Practice Address - Zip Code:03276-5114
Practice Address - Country:US
Practice Address - Phone:603-286-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2723Medicaid
NH30423321Medicaid
NHHA - RE8314Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER