MEDICARE: MS. MISHELE LEE HART LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW5792	FL

General Provider Information

NPI Number	:	1083797724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MISHELE LEE HART LCSW

Provider Business Mailing Address
First Line	:	7855 ARGYLE FOREST BLVD. #907
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-7707
Country	:	US
Telephone Number	:	904-287-9195
Fax Number	:	904-317-9520

Provider Business Practice Location Address
First Line	:	7855 ARGYLE FOREST BLVD. #907
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-7707
Country	:	US
Telephone Number	:	904-287-9195
Fax Number	:	904-317-9520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	05/21/2024

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