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General NPI Number Information
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NPI Number | 1588483523
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Entity Type | Organization
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Legal Business Name | BREANNA HART THERAPY LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 1225 VT-15
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City | WOLCOTT
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State | VT
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Zip | 05680
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Country | US
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Telephone | 802-760-8191
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Fax |
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Provider Business Mailing Address
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Address Line | 1225 VT-15
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City | WOLCOTT
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State | VT
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Zip | 05680-4560
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Country | US
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Telephone | 802-308-5445
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Fax | 802-308-5445
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | BREANNA HART
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Credential | MSW, LICSW
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Telephone | 802-308-5445
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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 |
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License Number State |
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