Provider Demographics
NPI:1609824150
Name:HART, SANDRA JEAN (PHD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:HART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 SOUTH 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1018
Mailing Address - Country:US
Mailing Address - Phone:215-790-0665
Mailing Address - Fax:215-735-2447
Practice Address - Street 1:255 SOUTH 17TH STREET #2708
Practice Address - Street 2:THE MEDICAL TOWER BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6228
Practice Address - Country:US
Practice Address - Phone:215-545-7207
Practice Address - Fax:215-735-2447
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002198L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist