Provider Demographics
NPI:1013054998
Name:HETZEL, KAREN (PHD, APRN, BC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:HETZEL
Suffix:
Gender:F
Credentials:PHD, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 BELMONT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4436
Mailing Address - Country:US
Mailing Address - Phone:508-238-6956
Mailing Address - Fax:
Practice Address - Street 1:1342 BELMONT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4437
Practice Address - Country:US
Practice Address - Phone:508-583-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA144649364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA005176OtherVALUE OPTIONS
MA790700OtherTUFTS
MAPN0031OtherBCBS
MA1028770OtherFALLON-BEACON HEALTH STRA
MA306175OtherMAGELLAN
MAPN0031OtherBCBS