Provider Demographics
NPI:1831516004
Name:HOBART, HEIDI (MA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:HOBART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:HOBART-FERRARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1305 WOODSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1305 WOODSTOCK RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1061
Practice Address - Country:US
Practice Address - Phone:323-222-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACADDTP 1475101YA0400X
CPRP #157294101YM0800X
CALPCC936101YP2500X
ATCB#96-154221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist