Provider Demographics
NPI:1447446588
Name:HAZELTON, KATHLEEN ANNE (MA)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:HAZELTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 HOLTSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-9736
Mailing Address - Country:US
Mailing Address - Phone:978-544-3272
Mailing Address - Fax:
Practice Address - Street 1:185 HOLTSHIRE RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-9736
Practice Address - Country:US
Practice Address - Phone:978-544-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3027959104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker