MEDICARE: KATHERINE SANDRA HANLEY PMHNP-BC, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN2290510	MA
2	101YM0800X	Mental Health Counselor	8236	MA
3	163W00000X	Registered Nurse	RN2290510	MA

General Provider Information

NPI Number	:	1124282470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SANDRA HANLEY PMHNP-BC, LMHC

Provider Business Mailing Address
First Line	:	30 MEADOWBROOK RD
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7122
Country	:	US
Telephone Number	:	857-225-4076
Fax Number	:	508-408-6199

Provider Business Practice Location Address
First Line	:	30 MEADOWBROOK RD
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7122
Country	:	US
Telephone Number	:	857-225-4076
Fax Number	:	508-408-6199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	01/22/2020

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