Provider Demographics
NPI:1164907259
Name:HART, DUSTIN JAMES (RBT)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JAMES
Last Name:HART
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GLENDALE ST APT 10
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2744
Mailing Address - Country:US
Mailing Address - Phone:650-400-0113
Mailing Address - Fax:
Practice Address - Street 1:1633 OLD BAYSHORE HWY STE 155
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1515
Practice Address - Country:US
Practice Address - Phone:650-376-4230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician