Provider Demographics
NPI:1912996463
Name:HART, MARY MARGARET (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARGARET
Last Name:HART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-8852
Mailing Address - Country:US
Mailing Address - Phone:814-355-5595
Mailing Address - Fax:814-353-9722
Practice Address - Street 1:2703 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-8852
Practice Address - Country:US
Practice Address - Phone:814-355-5595
Practice Address - Fax:814-353-9722
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004804L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA109552OtherVALUEOPTIONS
PA01116802OtherCAPITAL BLUE CROSS (CAIC)
PA461353OtherHIGHMARK BLUE SHIELD
PAD61353OtherAMERIHEALTH ADMINISTRATOR
PA101758285 0001Medicaid
PA2057018OtherCIGNA BEHAVIORAL HEALTH
PAD61353OtherAMERIHEALTH ADMINISTRATOR
PAR07054Medicare UPIN
PA461353Medicare ID - Type Unspecified