Provider Demographics
NPI:1164664793
Name:TRACY HART, LCSW PSYCHOTHERAPY SERVICES LLC
Entity Type:Organization
Organization Name:TRACY HART, LCSW PSYCHOTHERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-913-0250
Mailing Address - Street 1:120 CHESTNUT TREE HILL ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 OLD SHERMAN TPKE
Practice Address - Street 2:SUITE 107
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4174
Practice Address - Country:US
Practice Address - Phone:203-913-0250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty