Provider Demographics
NPI:1003562893
Name:HACKETT, TIMOTHY MATTHEW (MA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MATTHEW
Last Name:HACKETT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MERCER ST APT 6K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6733
Mailing Address - Country:US
Mailing Address - Phone:917-428-3772
Mailing Address - Fax:
Practice Address - Street 1:300 MERCER ST APT 6K
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6733
Practice Address - Country:US
Practice Address - Phone:917-428-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst