Provider Demographics
NPI:1841565215
Name:HART, ADRIENNE L (MA, MFT)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:L
Last Name:HART
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RUBICON CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1040
Mailing Address - Country:US
Mailing Address - Phone:415-257-4046
Mailing Address - Fax:
Practice Address - Street 1:22 RUBICON CT
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1040
Practice Address - Country:US
Practice Address - Phone:415-257-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT#45080106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist