Basic Information
| Provider Information | |||||||||
| NPI: | 1225485212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEHART | ||||||||
| FirstName: | SAMMI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 773 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070902528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094397647 | ||||||||
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| Practice Location | |||||||||
| Address1: | 810 CLASSON AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112386102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182305100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2016 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 095518 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 44SC05813700 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.