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NPI Code Detail

MEDICARE: AMY HART

MEDICARE: AMY HART
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1972015568
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY HART
Provider Business Mailing Address
First Line : 715 LAKE ST STE 800
Second Line :
City : OAK PARK
State : IL
Zip : 60301-1417
Country : US
Telephone Number : 773-312-3612
Fax Number : 708-294-3699
Provider Business Practice Location Address
First Line : 715 LAKE ST STE 800
Second Line :
City : OAK PARK
State : IL
Zip : 60301-1417
Country : US
Telephone Number : 773-312-3612
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2017
Last Update Date : 11/03/2017

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