Provider Demographics
NPI:1316679939
Name:HART, RICHARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 GLENDALE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1814
Mailing Address - Country:US
Mailing Address - Phone:818-208-0566
Mailing Address - Fax:
Practice Address - Street 1:17702 SIERRA HWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-1635
Practice Address - Country:US
Practice Address - Phone:888-770-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94025719103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSB94025919OtherCALIFORNIA BOARD OF PSYCHOLOGY