Healthcare Provider Details

I. General information

NPI: 1831381870
Provider Name (Legal Business Name): ELIZABETH LEARY HART PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH LEARY HART PH.D.

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OSLO CIR
BIRMINGHAM AL
35211-5937
US

IV. Provider business mailing address

405 BELCHER ST
CENTREVILLE AL
35042-2946
US

V. Phone/Fax

Practice location:
  • Phone: 205-944-3944
  • Fax:
Mailing address:
  • Phone: 205-926-2992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1710
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number001930
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: