Provider Demographics
NPI:1073698395
Name:HACKNEY, KRISTEN ANNE (MA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANNE
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WHITES AVE
Mailing Address - Street 2:APT #63
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4314
Mailing Address - Country:US
Mailing Address - Phone:617-769-7210
Mailing Address - Fax:
Practice Address - Street 1:24 WHITES AVE
Practice Address - Street 2:APT #63
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4314
Practice Address - Country:US
Practice Address - Phone:203-915-8599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA6385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health