Provider Demographics
NPI:1831237510
Name:HATTON, MARK DAVID (PHD, MED, MPHIL)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:HATTON
Suffix:
Gender:M
Credentials:PHD, MED, MPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1366
Mailing Address - Country:US
Mailing Address - Phone:201-638-6203
Mailing Address - Fax:
Practice Address - Street 1:300 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1932
Practice Address - Country:US
Practice Address - Phone:201-638-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100297000103T00000X, 103TA0400X, 103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5578302Medicaid
PAPS020054OtherPA PSYCHOLOGIST LICENSE
NJ35SI00297000OtherNJ PSYCHOLOGIST LICENSE