Provider Demographics
NPI:1851353775
Name:HART, NANCY K (PHD, MSW)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:K
Last Name:HART
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 E. STADIUM BLVD.
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4821
Mailing Address - Country:US
Mailing Address - Phone:734-929-6454
Mailing Address - Fax:734-926-0048
Practice Address - Street 1:2311 E. STADIUM BLVD.
Practice Address - Street 2:SUITE 109
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4821
Practice Address - Country:US
Practice Address - Phone:734-929-6454
Practice Address - Fax:734-926-0048
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010154301041C0700X
MI4101006013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350723000OtherMAGELLAN
MI051004OtherVALUE OPTIONS
MI0897034OtherBLUE CROSS/BLUE SHIELD
MI7746555OtherAETNA
MI11559207OtherCAQH
MI350723000OtherMAGELLAN