Provider Demographics
NPI:1326459587
Name:HIATT, EILEEN ROSE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:ROSE
Last Name:HIATT
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 1:113 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3008
Mailing Address - Country:US
Mailing Address - Phone:978-648-1747
Mailing Address - Fax:
Practice Address - Street 1:113 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3008
Practice Address - Country:US
Practice Address - Phone:978-648-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116028103TP2701X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy