Individual provider Active NPI

Lance R Hart, PH.D

  • Clinical Psychologist
  • Branford, CT
National Provider Identifier
1578558573
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
000576 Issued in CT
Practice address
1 S Main St
#2
Branford, CT 06405-3872
Phone
(203) 488-3078
NPI assigned
Sep 15, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 000576 CT Primary

Addresses

Primary practice location

1 S Main St
#2
Branford, CT 06405-3872

Mailing address

1 S Main St
#2
Branford, CT 06405-3872
Phone (203) 488-3078

Other identifiers 1

IdentifierTypeStateIssuer
060000576CT01OtherCTANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120125000341 CT Practitioner - Clinical Psychologist 1951578376 Practice locations: Branford, CT

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Emory University School of Medicine, 1971
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1 S Main St
Branford, CT 06405-3872
Phone (203) 488-3078

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
000576CTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Barbara a. Moynihan LLC PastSince Mar 19, 2016 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578558573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 S MAIN ST",
            "address_2": "#2",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064053872",
            "telephone_number": "203-488-3078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S MAIN ST",
            "address_2": "#2",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064053872",
            "telephone_number": "203-488-3078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HART",
        "first_name": "LANCE",
        "middle_name": "R",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "000576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "060000576CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Branford, CT

Sources for this page

Verify at the official NPI Registry.