Provider Demographics
NPI:1093911067
Name:HATHAWAY, CHRISTINA R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:R
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2145
Mailing Address - Country:US
Mailing Address - Phone:908-232-2333
Mailing Address - Fax:
Practice Address - Street 1:128 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2145
Practice Address - Country:US
Practice Address - Phone:908-232-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00324100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ034561Medicare ID - Type Unspecified