Provider Demographics
NPI:1205579232
Name:HART, TAMMY
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:RUFFS DALE
Mailing Address - State:PA
Mailing Address - Zip Code:15679-1251
Mailing Address - Country:US
Mailing Address - Phone:724-953-7642
Mailing Address - Fax:
Practice Address - Street 1:4731 ROUTE 30 STE AND404
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7260
Practice Address - Country:US
Practice Address - Phone:724-537-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000344103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst