Provider Demographics
NPI:1578286183
Name:IMBERT, HAZELL (LMHC)
Entity Type:Individual
Prefix:
First Name:HAZELL
Middle Name:
Last Name:IMBERT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WASHINGTON ST # 129
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3607
Mailing Address - Country:US
Mailing Address - Phone:617-380-3806
Mailing Address - Fax:
Practice Address - Street 1:75 STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1826
Practice Address - Country:US
Practice Address - Phone:617-380-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health