=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932752821
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH L. HART LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2019
-----------------------------------------------------
Last Update Date | 07/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 ROCKWOOD PL
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-4957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-292-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 92 RANDOLPH AVE
-----------------------------------------------------
City | DUMONT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07628-1920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-936-4724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05787100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------