Provider Demographics
NPI:1437596459
Name:HART, JONATHAN VINCENT (LCSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:VINCENT
Last Name:HART
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 W LELAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3501
Mailing Address - Country:US
Mailing Address - Phone:419-357-8032
Mailing Address - Fax:
Practice Address - Street 1:2429 W LELAND AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3501
Practice Address - Country:US
Practice Address - Phone:419-357-8032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0154711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical