Provider Demographics
NPI:1629419379
Name:HACKETT, ROBERTA B (RN, CNS)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:B
Last Name:HACKETT
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:B
Other - Last Name:FEATHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:70 ELMGROVE AVE.
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-272-0297
Mailing Address - Fax:
Practice Address - Street 1:70 ELMGROVE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-272-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPNS00039102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst