Provider Demographics
NPI:1689732794
Name:HULL, ETHEL I (PHD)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:I
Last Name:HULL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BAPTIST ROAD
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03224
Mailing Address - Country:US
Mailing Address - Phone:603-224-2448
Mailing Address - Fax:603-783-0427
Practice Address - Street 1:115 BAPTIST ROAD
Practice Address - Street 2:
Practice Address - City:CANTERBURY
Practice Address - State:NH
Practice Address - Zip Code:03224
Practice Address - Country:US
Practice Address - Phone:603-224-2448
Practice Address - Fax:603-783-0427
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80626865Medicaid
NH80626865Medicaid