Provider Demographics
NPI:1184886707
Name:HART, RACHEL LOUISE (MS)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LOUISE
Last Name:HART
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHURCH ST S
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1717
Mailing Address - Country:US
Mailing Address - Phone:203-737-4791
Mailing Address - Fax:203-737-1272
Practice Address - Street 1:2 CHURCH ST S
Practice Address - Street 2:SUITE 209
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1717
Practice Address - Country:US
Practice Address - Phone:203-737-4791
Practice Address - Fax:203-737-1272
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000143101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)