Provider Demographics
NPI:1205459195
Name:WHITE, HANNATU T
Entity type:Individual
Prefix:
First Name:HANNATU
Middle Name:T
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 WEST ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1552
Mailing Address - Country:US
Mailing Address - Phone:781-228-8364
Mailing Address - Fax:
Practice Address - Street 1:265 WEST ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1552
Practice Address - Country:US
Practice Address - Phone:781-228-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA106E00000XOtherLAMOUR CLINIC