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General NPI Number Information
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NPI Number | 1093049785
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Entity Type | Individual
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Provider Name | JODIE L HART LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 608 BLEDSOE RD NW
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6219
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Country | US
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Telephone | 505-450-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 3326 LINDA VISTA AVE SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-1514
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Country | US
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Telephone | 505-450-8007
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Fax | 505-268-8949
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | M-06061
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | X-06862
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License Number State | NM
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