Provider Demographics
NPI:1588814032
Name:HART, EDNA PATRICIA (MS , MFT)
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:PATRICIA
Last Name:HART
Suffix:
Gender:F
Credentials:MS , MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3478 BUSKIRK AVE
Mailing Address - Street 2:SUITE 1006
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4344
Mailing Address - Country:US
Mailing Address - Phone:925-746-7178
Mailing Address - Fax:
Practice Address - Street 1:3478 BUSKIRK AVE
Practice Address - Street 2:SUITE 1006
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4344
Practice Address - Country:US
Practice Address - Phone:925-746-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMN022245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist