Provider Demographics
NPI:1760424766
Name:HART, JOAN BLANTON (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:BLANTON
Last Name:HART
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 QUARRY RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6949
Mailing Address - Country:US
Mailing Address - Phone:301-469-8064
Mailing Address - Fax:
Practice Address - Street 1:110 N WASHINGTON ST
Practice Address - Street 2:SUITE 407
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2223
Practice Address - Country:US
Practice Address - Phone:301-738-2078
Practice Address - Fax:301-738-1636
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD041161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD700645Medicare ID - Type UnspecifiedMEDICARE