Provider Demographics
NPI:1861700213
Name:HART, SIOBHAN
Entity type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
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:PO BOX 1793
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-0205
Mailing Address - Country:US
Mailing Address - Phone:415-857-2504
Mailing Address - Fax:
Practice Address - Street 1:2198 6TH ST
Practice Address - Street 2:STE. 100
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2233
Practice Address - Country:US
Practice Address - Phone:510-848-1112
Practice Address - Fax:510-848-4445
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27077103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist