=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730451667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARTWORKS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2012
-----------------------------------------------------
Last Update Date | 02/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 PFEFFER LN
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790-3525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-921-8408
-----------------------------------------------------
Fax | 860-496-9341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 PFEFFER LN
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790-3525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-921-8408
-----------------------------------------------------
Fax | 860-496-9341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEBRA S. HART
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 860-921-8408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6833
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------