Basic Information
| Provider Information | |||||||||
| NPI: | 1396110409 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASBUN | ||||||||
| FirstName: | AMELIA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 96 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | WARE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010821616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4139676241 | ||||||||
| FaxNumber: | 4139679807 | ||||||||
| Practice Location | |||||||||
| Address1: | 96 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | WARE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010821616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4139676241 | ||||||||
| FaxNumber: | 4139679807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2015 | ||||||||
| LastUpdateDate: | 11/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.