Provider Demographics
NPI:1942406608
Name:STAVIS, HASSON LAMAR
Entity Type:Individual
Prefix:MR
First Name:HASSON
Middle Name:LAMAR
Last Name:STAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 CHURCH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2313
Mailing Address - Country:US
Mailing Address - Phone:860-982-7271
Mailing Address - Fax:
Practice Address - Street 1:532 CHURCH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2313
Practice Address - Country:US
Practice Address - Phone:860-982-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist