Provider Demographics
NPI:1588016836
Name:HARDT, CARMEN JO (RN, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:JO
Last Name:HARDT
Suffix:
Gender:F
Credentials:RN, LMFT
Other - Prefix:MS
Other - First Name:CARMYN
Other - Middle Name:JO COY
Other - Last Name:HARDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:388 PANTANO CIR
Mailing Address - Street 2:
Mailing Address - City:PACHECO
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5632
Mailing Address - Country:US
Mailing Address - Phone:925-286-2219
Mailing Address - Fax:925-288-1587
Practice Address - Street 1:1350 HAYES ST
Practice Address - Street 2:SUITE B9
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2945
Practice Address - Country:US
Practice Address - Phone:925-286-2219
Practice Address - Fax:925-288-1587
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84687106H00000X
CA365484163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health