Provider Demographics
NPI:1326192618
Name:HANTMAN, ELAINE SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:SUSAN
Last Name:HANTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2843
Mailing Address - Country:US
Mailing Address - Phone:413-458-4213
Mailing Address - Fax:413-458-4213
Practice Address - Street 1:10 MEADOW ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2843
Practice Address - Country:US
Practice Address - Phone:413-458-4213
Practice Address - Fax:413-458-4213
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3315103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1898558Medicaid
MAW03357OtherBLUE CROSS BLUESHIELD
MAW03357OtherBLUE CROSS BLUESHIELD