Provider Demographics
NPI:1225501182
Name:HART, BECKY JANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:JANE
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 1:1588 E BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:IL
Mailing Address - Zip Code:61459-9343
Mailing Address - Country:US
Mailing Address - Phone:309-255-2475
Mailing Address - Fax:
Practice Address - Street 1:225 1/2 W MAIN ST.
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644
Practice Address - Country:US
Practice Address - Phone:309-255-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0156161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical