Provider Demographics
NPI:1346687605
Name:HACKETT, JOHN TERRANCE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TERRANCE
Last Name:HACKETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:JOHN TERRANCE HACKETT MD
Mailing Address - City:DELHI
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-667-9304
Mailing Address - Fax:209-669-3978
Practice Address - Street 1:9226 HINTON AVE
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:CA
Practice Address - Zip Code:95315-8200
Practice Address - Country:US
Practice Address - Phone:209-667-9304
Practice Address - Fax:209-669-3978
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA23729103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation