Provider Demographics
NPI:1851434328
Name:HARE, NATHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:HARE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NELSON ROAD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-765-6940
Mailing Address - Fax:607-754-5138
Practice Address - Street 1:256 HARRY L DRIVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-765-6940
Practice Address - Fax:607-754-5138
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005631-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY38082BMedicare ID - Type Unspecified
NYR55257Medicare UPIN