Provider Demographics
NPI:1972045706
Name:HART, KATHERINE (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-0865
Mailing Address - Country:US
Mailing Address - Phone:719-966-2040
Mailing Address - Fax:
Practice Address - Street 1:131 W MAIN ST
Practice Address - Street 2:STE 209
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1158
Practice Address - Country:US
Practice Address - Phone:719-966-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107693101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor