Provider Demographics
NPI:1134333131
Name:HASSELL, SHAWN JASON (MS)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:JASON
Last Name:HASSELL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 OLD HEDDING RD
Mailing Address - Street 2:UNIT 13
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-2344
Mailing Address - Country:US
Mailing Address - Phone:603-679-8024
Mailing Address - Fax:603-641-3499
Practice Address - Street 1:540 CHESTNUT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1447
Practice Address - Country:US
Practice Address - Phone:603-223-4062
Practice Address - Fax:603-641-3499
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH69106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y007402NH01OtherBHN, ANTHEM, BCBSNH
NH30424646Medicaid