Provider Demographics
NPI:1912742610
Name:HART, CLAYISHA S
Entity type:Individual
Prefix:
First Name:CLAYISHA
Middle Name:S
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SOLAR CIR
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6819
Mailing Address - Country:US
Mailing Address - Phone:410-260-0446
Mailing Address - Fax:
Practice Address - Street 1:12774 WISTERIA DR UNIT 163
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20875-7507
Practice Address - Country:US
Practice Address - Phone:240-813-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28921104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker