Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS1028 | ME |
NPI | 1114933199 |
---|---|
Provider Name | Dr. Kathleen M Hart |
First Address | Falmouth, ME 04105-1189 |
Second Address | Falmouth, ME 04105-1189 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041453 | ME BLUE SHIELD (01) | ME |