Provider Demographics
NPI:1750357935
Name:HATALA, CAROLINE MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MARIE
Last Name:HATALA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:AIEMIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 CLINTON ST
Mailing Address - Street 2:NEW HAMPSHIRE HOSPITAL
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2359
Mailing Address - Country:US
Mailing Address - Phone:603-271-5464
Mailing Address - Fax:
Practice Address - Street 1:36 CLINTON ST
Practice Address - Street 2:NEW HAMPSHIRE HOSPITAL
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2359
Practice Address - Country:US
Practice Address - Phone:603-271-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH861103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422966Medicaid
NHRE4807Medicare ID - Type Unspecified