1700971249 NPI number — MR. CRAIG HOYT HADLEY LICSW

Table of content: MR. CRAIG HOYT HADLEY LICSW (NPI 1700971249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700971249 NPI number — MR. CRAIG HOYT HADLEY LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADLEY
Provider First Name:
CRAIG
Provider Middle Name:
HOYT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1700971249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 306A
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03820-3744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-742-0806
Provider Business Mailing Address Fax Number:
603-742-0806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 306A
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03820-3744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-742-0806
Provider Business Practice Location Address Fax Number:
603-742-0877
Provider Enumeration Date:
10/03/2006

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: 104100000X , with the licence number:  811 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 014549 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112602 . This is a "TEAMSTERS BEHAVIORAL HEAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1400872Y0NH01 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30422274 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 492344000 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30426954 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 393207 . This is a "MBC" identifier . This identifiers is of the category "OTHER".




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