Provider Demographics
NPI:1619022399
Name:HANNIFIN, EDWARD JAMES V (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JAMES
Last Name:HANNIFIN
Suffix:V
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 NEW ESTATE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1108
Mailing Address - Country:US
Mailing Address - Phone:978-486-8418
Mailing Address - Fax:
Practice Address - Street 1:22 KING ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-1519
Practice Address - Country:US
Practice Address - Phone:978-952-6809
Practice Address - Fax:978-952-8607
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health