Provider Demographics
NPI:1750327912
Name:HAZLETT, ROBERT T (LCSW, PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:HAZLETT
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-3926
Mailing Address - Country:US
Mailing Address - Phone:609-494-1554
Mailing Address - Fax:609-361-9553
Practice Address - Street 1:4700 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08008-3926
Practice Address - Country:US
Practice Address - Phone:609-494-1554
Practice Address - Fax:609-361-9553
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00157900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0094251Medicaid
NJHA634470Medicare ID - Type Unspecified