MEDICARE: DR. PATRICIA HART PH.D.

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	103TC0700X	Clinical Psychologist	PSY 6618	CA

General Provider Information

NPI Number	:	1861515736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA HART PH.D.

Provider Business Mailing Address
First Line	:	921 THE ALAMEDA
Second Line	:	SUITE 102
City	:	BERKELEY
State	:	CA
Zip	:	94707-2311
Country	:	US
Telephone Number	:	510-527-9039
Fax Number	:	510-848-4040

Provider Business Practice Location Address
First Line	:	921 THE ALAMEDA
Second Line	:	SUITE 102
City	:	BERKELEY
State	:	CA
Zip	:	94707-2311
Country	:	US
Telephone Number	:	510-527-9039
Fax Number	:	510-848-4040

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

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	07/08/2007

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