=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326559600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HART TO HART PSYCHOLOGICAL ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2017
-----------------------------------------------------
Last Update Date | 10/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 S ROCKBURN ST
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-2862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-600-8181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 S ROCKBURN ST
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-2862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-600-8181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. BARRY BLAKISTON HART
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 717-600-8181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSO15378
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------