Healthcare Provider Details

I. General information

NPI: 1366517757
Provider Name (Legal Business Name): SARA HART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2261
SHOW LOW AZ
85902-2261
US

IV. Provider business mailing address

PO BOX 2261
SHOW LOW AZ
85902-2261
US

V. Phone/Fax

Practice location:
  • Phone: 928-200-2446
  • Fax:
Mailing address:
  • Phone: 928-200-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8510
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberAN486480
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15850
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: