Provider Demographics
NPI:1831248913
Name:HART, GORDON MAX JR (PHD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:MAX
Last Name:HART
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3928
Mailing Address - Country:US
Mailing Address - Phone:610-325-5552
Mailing Address - Fax:
Practice Address - Street 1:90 HUNTERS RUN
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3928
Practice Address - Country:US
Practice Address - Phone:610-325-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA001500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist