Basic Information
| Provider Information | |||||||||
| NPI: | 1861700213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | SIOBHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1793 | ||||||||
| Address2: | |||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945010205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158572504 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2198 6TH ST | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947102233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108481112 | ||||||||
| FaxNumber: | 5108484445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2010 | ||||||||
| LastUpdateDate: | 03/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY27077 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.