Provider Demographics
NPI:1275638223
Name:HART, KATHRYN LYNNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LYNNE
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 1:3220 ALLNESS LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3324
Mailing Address - Country:US
Mailing Address - Phone:703-481-6337
Mailing Address - Fax:
Practice Address - Street 1:425 CARLISLE DR
Practice Address - Street 2:SUITE B
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4802
Practice Address - Country:US
Practice Address - Phone:703-467-9036
Practice Address - Fax:703-467-9508
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040061011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical