Healthcare Provider Details

I. General information

NPI: 1053498816
Provider Name (Legal Business Name): PAUL HART LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W BROAD ST UNIT 7140
FALLS CHURCH VA
22040-8067
US

IV. Provider business mailing address

800 W BROAD ST UNIT 7140
FALLS CHURCH VA
22040-8067
US

V. Phone/Fax

Practice location:
  • Phone: 703-352-9851
  • Fax:
Mailing address:
  • Phone: 703-352-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004480
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: