Provider Demographics
NPI:1467466334
Name:HART, JESSICA MITCHELL (MA LIC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MITCHELL
Last Name:HART
Suffix:
Gender:F
Credentials:MA LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-4147
Mailing Address - Country:US
Mailing Address - Phone:717-486-3929
Mailing Address - Fax:
Practice Address - Street 1:3235 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1308
Practice Address - Country:US
Practice Address - Phone:717-234-3839
Practice Address - Fax:717-234-6247
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006260L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02105001OtherCAPITAL BLUE CROSS
PA000764545OtherHIGHMARK BLUE SHIELD