Provider Demographics
NPI:1114090552
Name:HALE, NANCY L (MED, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:HALE
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STAFFORD ST STE 254
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3500
Mailing Address - Country:US
Mailing Address - Phone:413-748-7010
Mailing Address - Fax:
Practice Address - Street 1:300 STAFFORD ST STE 254
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3500
Practice Address - Country:US
Practice Address - Phone:413-748-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1305263Medicaid