Provider Demographics
NPI:1750398715
Name:PSYCHIATRIC PSYCHOLOGICAL & THERAPEUTIC
Entity type:Organization
Organization Name:PSYCHIATRIC PSYCHOLOGICAL & THERAPEUTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LIC
Authorized Official - Phone:717-234-3839
Mailing Address - Street 1:3235 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1308
Mailing Address - Country:US
Mailing Address - Phone:717-234-3838
Mailing Address - Fax:717-234-6247
Practice Address - Street 1:3235 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1308
Practice Address - Country:US
Practice Address - Phone:717-234-3838
Practice Address - Fax:717-234-6247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000330833OtherHIGHMARK BLUE SHIELD
PA0250400OtherCAPITAL BLUE CROSS