Provider Demographics
NPI:1750775771
Name:HAMBERG, HENRICK
Entity type:Individual
Prefix:
First Name:HENRICK
Middle Name:
Last Name:HAMBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MOUNT HENRY RD
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01464-2011
Mailing Address - Country:US
Mailing Address - Phone:978-368-6761
Mailing Address - Fax:
Practice Address - Street 1:14 MOUNT HENRY RD
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2011
Practice Address - Country:US
Practice Address - Phone:978-368-6761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2364174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator