Provider Demographics
NPI:1609969260
Name:HART, KARIN SALISBURY (PSYD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:SALISBURY
Last Name:HART
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30423 CANWOOD ST
Mailing Address - Street 2:SUITE 129
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2082
Mailing Address - Country:US
Mailing Address - Phone:818-707-4443
Mailing Address - Fax:818-707-1181
Practice Address - Street 1:30423 CANWOOD ST
Practice Address - Street 2:SUITE 129
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2082
Practice Address - Country:US
Practice Address - Phone:818-707-4443
Practice Address - Fax:818-707-1181
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16672103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical