Provider Demographics
NPI:1396110409
Name:HASBUN, AMELIA NICOLE (LMFT)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:NICOLE
Last Name:HASBUN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 GREENWOOD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1837
Mailing Address - Country:US
Mailing Address - Phone:774-519-7980
Mailing Address - Fax:
Practice Address - Street 1:1 EMERSON PL # 3H
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2252
Practice Address - Country:US
Practice Address - Phone:617-397-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMFT1830106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist