Provider Demographics
NPI:1710087317
Name:HART, NANCY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
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 1:8841 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2847
Mailing Address - Country:US
Mailing Address - Phone:225-769-7886
Mailing Address - Fax:
Practice Address - Street 1:8841 BLUEBONNET BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2847
Practice Address - Country:US
Practice Address - Phone:225-769-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28081041C0700X
LA491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3T011Medicare ID - Type Unspecified