Provider Demographics
NPI:1407289218
Name:HART, TRINITY SAGE (MFT)
Entity Type:Individual
Prefix:
First Name:TRINITY
Middle Name:SAGE
Last Name:HART
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 RIO RANCHO BLVD SE # 306
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1006
Mailing Address - Country:US
Mailing Address - Phone:707-489-5849
Mailing Address - Fax:
Practice Address - Street 1:4619 GREENE ST NW STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4899
Practice Address - Country:US
Practice Address - Phone:505-899-9329
Practice Address - Fax:505-899-9729
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95736106H00000X
NMCMF0222281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist