Basic Information
| Provider Information | |||||||||
| NPI: | 1467757559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAGGERTY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | PHILIP | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.M.H.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 319 BEECH ST | ||||||||
| Address2: | |||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010403968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135401155 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 319 BEECH ST | ||||||||
| Address2: | |||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010403968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135401155 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2011 | ||||||||
| LastUpdateDate: | 01/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3877 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.