Provider Demographics
NPI:1851409312
Name:HATTEMER, MARY S (LISW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:HATTEMER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NW WASHINGTON BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-5834
Mailing Address - Country:US
Mailing Address - Phone:513-869-7000
Mailing Address - Fax:515-785-4272
Practice Address - Street 1:2201 NW WASHINGTON BLVD
Practice Address - Street 2:STE A
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-5834
Practice Address - Country:US
Practice Address - Phone:513-869-7000
Practice Address - Fax:515-785-4272
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0005217104100000X
KY1035104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
R72211Medicare UPIN
HASW10803Medicare ID - Type Unspecified