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
StateLicense IDTaxonomies
103TC2200X
MA390200000X
MA11608103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program