MEDICARE: JESSICA HART MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00633000	NJ

General Provider Information

NPI Number	:	1467927780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HART MA, LPC

Provider Business Mailing Address
First Line	:	200 MAIN ST STE B
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-7415
Country	:	US
Telephone Number	:	732-703-6864
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MAIN ST STE B
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-7415
Country	:	US
Telephone Number	:	732-703-6864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	08/03/2022

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