Provider Demographics
NPI:1225121775
Name:HALL, ALBERT JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JOHN
Last Name:HALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 GARDNER ST
Mailing Address - Street 2:PO BOX 296
Mailing Address - City:HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01936-0296
Mailing Address - Country:US
Mailing Address - Phone:978-468-3056
Mailing Address - Fax:978-626-0031
Practice Address - Street 1:136 GARDNER ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01936-0296
Practice Address - Country:US
Practice Address - Phone:978-468-3056
Practice Address - Fax:978-626-0031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0515647Medicaid
MAR93416Medicare UPIN
MAW01147Medicare ID - Type Unspecified