Provider Demographics
NPI:1700992104
Name:HEMLEY, ELIZABETH MALVINA (DRS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MALVINA
Last Name:HEMLEY
Suffix:
Gender:F
Credentials:DRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2620
Mailing Address - Country:US
Mailing Address - Phone:413-256-6004
Mailing Address - Fax:413-256-4571
Practice Address - Street 1:409 MAIN ST STE 109
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2351
Practice Address - Country:US
Practice Address - Phone:413-256-6004
Practice Address - Fax:413-256-4571
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W02482Medicare ID - Type Unspecified