Provider Demographics
NPI:1497549372
Name:HART, KIMBERLY D (LSW, LCADC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:HART
Suffix:
Gender:F
Credentials:LSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 HAINESPORT MOUNT LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9516
Mailing Address - Country:US
Mailing Address - Phone:609-781-4339
Mailing Address - Fax:
Practice Address - Street 1:2707 VENTNOR AVE APT A
Practice Address - Street 2:
Practice Address - City:LONGPORT
Practice Address - State:NJ
Practice Address - Zip Code:08403-1251
Practice Address - Country:US
Practice Address - Phone:609-781-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00400200101YA0400X
NJ44SL0742000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)