Provider Demographics
NPI:1710977483
Name:HEBBEN, NANCY (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:HEBBEN
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 1:50 FAIRHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3424
Mailing Address - Country:US
Mailing Address - Phone:617-969-4229
Mailing Address - Fax:617-969-4229
Practice Address - Street 1:275 GROVE ST
Practice Address - Street 2:BLDG 2, SUITE 400
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02466-2272
Practice Address - Country:US
Practice Address - Phone:617-663-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2598103G00000X, 103T00000X
OK998103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0518751OtherMASSHEALTH
MAHE W03003Medicare ID - Type Unspecified
MA0518751OtherMASSHEALTH