MEDICARE: MRS. DIANNA HACK 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	0904006275	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174662688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANNA HACK HART LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1797
Second Line	:
City	:	SPOTSYLVANIA
State	:	VA
Zip	:	22553-6797
Country	:	US
Telephone Number	:	540-226-3061
Fax Number	:

Provider Business Practice Location Address
First Line	:	8915 MILLWOOD DR
Second Line	:
City	:	SPOTSYLVANIA
State	:	VA
Zip	:	22551-3320
Country	:	US
Telephone Number	:	540-226-3061
Fax Number	:

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/06/2012

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