MEDICARE: NERISSA KADEY HATTER NCC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1174112676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NERISSA KADEY HATTER NCC

Provider Business Mailing Address
First Line	:	1317 E PALMER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-3320
Country	:	US
Telephone Number	:	209-543-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-3836
Country	:	US
Telephone Number	:	267-636-0236
Fax Number	:

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

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	01/11/2021

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