Provider Demographics
NPI:1265014518
Name:HACKETT, EARTHA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:EARTHA
Middle Name:M
Last Name:HACKETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EARTHA
Other - Middle Name:M
Other - Last Name:SIMPSON-HACKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DR
Mailing Address - Street 1:13037 235TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1215
Mailing Address - Country:US
Mailing Address - Phone:646-209-3753
Mailing Address - Fax:
Practice Address - Street 1:13037 235TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1215
Practice Address - Country:US
Practice Address - Phone:646-209-3753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024082-01103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling