Healthcare Provider Details

I. General information

NPI: 1801894803
Provider Name (Legal Business Name): IRENE D HASSETT PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15288 W BROOKSIDE LANE SUITE 131
SURPRISE AZ
85374
US

IV. Provider business mailing address

18478 N CANAL DRIVE
SURPRISE AZ
85374
US

V. Phone/Fax

Practice location:
  • Phone: 623-466-7927
  • Fax: 623-466-7927
Mailing address:
  • Phone: 623-466-7927
  • Fax: 623-466-7927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS007842L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: