Provider Demographics
NPI:1326674045
Name:HART, JENNIFER DIANO (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANO
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 1:1765 GRAVENHURST DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8651
Mailing Address - Country:US
Mailing Address - Phone:757-581-9937
Mailing Address - Fax:
Practice Address - Street 1:1765 GRAVENHURST DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-8651
Practice Address - Country:US
Practice Address - Phone:757-581-9937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040115251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical