Provider Demographics
NPI:1134257223
Name:HART, SARAH LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:LYNN
Last Name:HART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 CLEVELAND AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5053
Mailing Address - Country:US
Mailing Address - Phone:612-802-9164
Mailing Address - Fax:888-899-1514
Practice Address - Street 1:475 CLEVELAND AVE N STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5053
Practice Address - Country:US
Practice Address - Phone:612-802-9164
Practice Address - Fax:888-899-1514
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5592103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ961153Medicaid