Provider Demographics
NPI:1174675284
Name:HADLEY, AMY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:HADLEY
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 1:1234 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1703
Mailing Address - Country:US
Mailing Address - Phone:857-998-0747
Mailing Address - Fax:
Practice Address - Street 1:1234 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1703
Practice Address - Country:US
Practice Address - Phone:857-998-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10195081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO6114OtherBLUE CROSS BLUE SHIELD
MAPO6114OtherMEDEX
MAPO6114OtherMEDEX