Provider Demographics
NPI:1154508588
Name:HART, BETH ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANNE
Last Name:HART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 BRISTOL TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-1708
Mailing Address - Country:US
Mailing Address - Phone:847-910-0343
Mailing Address - Fax:847-719-2123
Practice Address - Street 1:1490 BRISTOL TRAIL RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-1708
Practice Address - Country:US
Practice Address - Phone:847-910-0343
Practice Address - Fax:847-719-2123
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical