Provider Demographics
NPI:1942440664
Name:HART, MONIQUE LA-RUTH (MSW, LCSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:LA-RUTH
Last Name:HART
Suffix:
Gender:F
Credentials:MSW, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-1614
Mailing Address - Country:US
Mailing Address - Phone:856-842-4210
Mailing Address - Fax:856-341-9289
Practice Address - Street 1:141 S BLACK HORSE PIKE STE 102
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-842-4210
Practice Address - Fax:856-341-9289
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057319001041C0700X
MD17759104100000X
PASW126977104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty