Provider Demographics
NPI: | 1821650664 |
---|---|
Name: | HARTNETT, EMILY I (PHD) |
Entity Type: | Individual |
Prefix: | |
First Name: | EMILY |
Middle Name: | I |
Last Name: | HARTNETT |
Suffix: | |
Gender: | F |
Credentials: | PHD |
Other - Prefix: | |
Other - First Name: | EMILY |
Other - Middle Name: | I |
Other - Last Name: | ANDERBERG |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | PHD |
Mailing Address - Street 1: | 1 MAGUIRE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | LEXINGTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02421-3114 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 781-860-1719 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1 MAGUIRE RD |
Practice Address - Street 2: | LURIE CENTER |
Practice Address - City: | LEXINGTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02421-3114 |
Practice Address - Country: | US |
Practice Address - Phone: | 781-860-1700 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-07-02 |
Last Update Date: | 2021-10-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
103TC2200X | ||
MA | 390200000X | |
MA | 11608 | 103TC0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |