Provider Demographics
NPI:1194728204
Name:HART, LEE ANN (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:LEE ANN
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 MADISON ST
Mailing Address - Street 2:STE 100S
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6080
Mailing Address - Country:US
Mailing Address - Phone:310-375-8981
Mailing Address - Fax:
Practice Address - Street 1:24050 MADISON ST
Practice Address - Street 2:STE 100S
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6080
Practice Address - Country:US
Practice Address - Phone:310-375-8981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS97891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR96110Medicare ID - Type Unspecified