Provider Demographics
NPI:1073980074
Name:HATTEM, CORY
Entity Type:Individual
Prefix:MS
First Name:CORY
Middle Name:
Last Name:HATTEM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CORY
Other - Middle Name:
Other - Last Name:HATTEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSW
Mailing Address - Street 1:274 8TH AVE
Mailing Address - Street 2:APT. 5A
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1160
Mailing Address - Country:US
Mailing Address - Phone:516-509-7156
Mailing Address - Fax:
Practice Address - Street 1:274 8TH AVE
Practice Address - Street 2:APT. 5A
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1160
Practice Address - Country:US
Practice Address - Phone:516-509-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03180811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical