Provider Demographics
NPI:1003981366
Name:HACKETT, TIA MADAFFARI (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:MADAFFARI
Last Name:HACKETT
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 ISLINGTON STREET
Mailing Address - Street 2:SUITE 13
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-766-5066
Mailing Address - Fax:603-766-5556
Practice Address - Street 1:1039 ISLINGTON STREET
Practice Address - Street 2:SUITE 13
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-766-5066
Practice Address - Fax:603-766-5556
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH89106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706655Y0NH01OtherBHN
NH99003227Medicaid
NH99003227Medicaid