MEDICARE: KARIN SALISBURY HART PSYD

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	103TC0700X	Clinical Psychologist	16672	CA

General Provider Information

NPI Number	:	1609969260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIN SALISBURY HART PSYD

Provider Business Mailing Address
First Line	:	30423 CANWOOD ST
Second Line	:	SUITE 129
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2082
Country	:	US
Telephone Number	:	818-707-4443
Fax Number	:	818-707-1181

Provider Business Practice Location Address
First Line	:	30423 CANWOOD ST
Second Line	:	SUITE 129
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2082
Country	:	US
Telephone Number	:	818-707-4443
Fax Number	:	818-707-1181

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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