Provider Demographics
NPI:1770952517
Name:HART, COURTNEYANN (MSW)
Entity type:Individual
Prefix:
First Name:COURTNEYANN
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E RODGERS ST
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-3511
Mailing Address - Country:US
Mailing Address - Phone:610-308-6669
Mailing Address - Fax:
Practice Address - Street 1:225 S 69TH ST
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-4212
Practice Address - Country:US
Practice Address - Phone:610-352-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132685104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker