1689728537 NPI number — KEVIN CHRISTOPHER HERSHEY MA, M.DIV

Table of content: KEVIN CHRISTOPHER HERSHEY MA, M.DIV (NPI 1689728537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689728537 NPI number — KEVIN CHRISTOPHER HERSHEY MA, M.DIV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERSHEY
Provider First Name:
KEVIN
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, M.DIV
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689728537
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 SHEEHAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLYOKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01040-1024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-987-1116
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 MAPLE ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01105-1864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-737-0960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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