Provider Demographics
NPI:1093840498
Name:HARDY, DELLA K (LICSW)
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:K
Last Name:HARDY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ABBOTT LN
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1043
Mailing Address - Country:US
Mailing Address - Phone:978-887-4061
Mailing Address - Fax:978-664-0717
Practice Address - Street 1:599 NORTH AVE
Practice Address - Street 2:DR8
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1648
Practice Address - Country:US
Practice Address - Phone:978-887-4061
Practice Address - Fax:978-664-0717
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016292104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23202Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER