Provider Demographics
NPI:1134337454
Name:HART, VIRGINIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4474
Mailing Address - Country:US
Mailing Address - Phone:732-995-1339
Mailing Address - Fax:732-288-0587
Practice Address - Street 1:823 BAY AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4474
Practice Address - Country:US
Practice Address - Phone:732-995-1339
Practice Address - Fax:732-288-0587
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC006580001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0019801Medicaid
NJ164-793OtherPTAM/MEDICARE PROVIDER NUMBER
NJ164-793Medicare PIN
164793Medicare PIN
164793Medicare UPIN