MEDICARE: SANDRA JEAN HART PHD

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	103T00000X	Psychologist	PS002198L	PA

General Provider Information

NPI Number	:	1609824150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA JEAN HART PHD

Provider Business Mailing Address
First Line	:	502 SOUTH 25TH STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1018
Country	:	US
Telephone Number	:	215-790-0665
Fax Number	:	215-735-2447

Provider Business Practice Location Address
First Line	:	255 SOUTH 17TH STREET #2708
Second Line	:	THE MEDICAL TOWER BUILDING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6228
Country	:	US
Telephone Number	:	215-545-7207
Fax Number	:	215-735-2447

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	09/11/2007

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