Provider Demographics
NPI:1346340742
Name:HART, SUZANNE CARLTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:CARLTON
Last Name:HART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TWO SAINT MARK'S PLACE
Mailing Address - Street 2:SUITE 147
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945
Mailing Address - Country:US
Mailing Address - Phone:979-530-8246
Mailing Address - Fax:
Practice Address - Street 1:TWO SAINT MARK'S PLACE
Practice Address - Street 2:SUITE 147
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945
Practice Address - Country:US
Practice Address - Phone:979-530-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical