Provider Demographics
NPI:1811359029
Name:HALE, AMY E (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:HALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MASSACHUSETTS AVE STE 84
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3071
Mailing Address - Country:US
Mailing Address - Phone:617-580-0888
Mailing Address - Fax:
Practice Address - Street 1:875 MASSACHUSETTS AVE STE 84
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3071
Practice Address - Country:US
Practice Address - Phone:617-580-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-26
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003506103TC0700X
MA10406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical